A Message to the Pastoral Care Team

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This form is an easy way to let Grace Episcopal Church clergy, staff, and co-chairs of the Pastoral Care teams know of the need for support at times of need, celebration, and transition. Please know that all information provided via this form will remain confidential and available only to clergy and church administrator, and Pastoral Care leadership. Please contact us...

When you become seriously ill, are dealing with a newly diagnosed disease or condition, or are hospitalized for treatment, surgery, or rehabilitation
When you are experiencing a spiritual, physical, emotional or financial crisis
When you become concerned for the person who usually shares the pew with you because he or she has not been in church for a while
When you experience one of life's many transitions: a birth, a death, a job loss/change, a move, an empty nest, retirement, etc.
When you need prayer and care but don't want to "bother" anyone with your troubles -- please contact us anyway; you will not be "bothering" us!

Your Name (first/last) *

Email Address (Pastoral Care's preferred method of communication) *

Phone Number (provide phone # and whether "mobile" or "landline")

For whom are you requesting pastoral care? *

For myself

For someone else

Please contact me.

Required

If you are reaching out on behalf of someone else, please provide a name and how to reach this person.

My request is related to *

Health and wellness

A transition (a move, job change, new child, etc)

Something to celebrate

Newcomer needing information

Need for a "visit", e.g., at home, in hospital, in care facility, etc. Please note that a first visit will most likely be from clergy.

Need for some occasional assistance, e.g., transportation, an errand, a meal or two, etc.

Other (please contact me)

Required

Please provide more details regarding your request (optional).

Anything else? (optional)

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