Prayer Request Form

Prayer Request Form
Date of submission*

MonthDayYear
Date
Please pray for*

First NameLast Name
Regarding*
ex. healing, having surgery, struggling, mental health, etc.
Is this request confidential?

yesno
Does this person know they are on our prayer list?

yesnouncertain
Special Requests
Relationship to you*
Your Full Name*

First NameLast Name
E-mail
example@example.com
Phone (if you wish to be contacted):
Any additional information you wish to share:
Your request will be added to our prayer list for 6 weeks. After which you are invited to submit another request for an additional 6 weeks. There is no limit to the number of requests you may submit if the situation is ongoing. You may note in the special request section if the need for prayer is shorter than 6 weeks.

Your Epiphany family is honored to join you in prayer.

Blessings
Should be Empty: