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