Stratford Hospital Visitation Request Form

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Stratford Hospital Visitation Request Form

This form is to request a pastoral visit for prayer before a surgery or medical procedure for Stratford Heights Church attenders.

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* Indicates required question

Your Name (first & last) *

Your answer

Your Mobile Phone Number *

Your answer

If no, what is your relationship to the person having surgery? *

Spouse

Parent

Grandparent

Aunt/Uncle

Friend

Other:

Required

If not you, what is the first & last name of person (patient) having surgery? *

Your answer

Patient's Mobile Phone Number *

Your answer

Does the patient actively attend Stratford Heights Church? *

Yes

No

Maybe

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