Congregational Care Form

What are you reporting? *

Sickness/health challenge for yourself or someone else

Death

Prayer request

Need

Other

Name *

First Name

Last Name

Phone

(###)

###

####

Would you like to be contacted? *

Yes

No

If not yourself, what is the person's name who needs care?

First Name

Last Name

What is the best way to contact you? *

Phone

Email

Is this person a member of New Jerusalem Tulsa? *

Yes

No

This information is:

Not Confidential - Your requests will be viewed and prayed for by congregants and staff committed to praying for our congregation

Confidential - Your request will only be viewed by our prayer team and New Jerusalem Tulsa staff