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Let us lift you up in prayer! Fill out this form to let us know if you would like our Prayer Chain or our congregation to pray for you.
The information you provide will remain confidential and will not be shared outside of our faith community.
Individual(s) making prayer request.
Your email address, in case there is a question.
Please provide your contact number, in case additional information is needed.
Disciple of Peace?
Please let us know if you are a member of Peace Lutheran Church, Peoria, AZ.
Please Pray For . . .
Please list the individual(s) you would like us to prayer for. If you do not want the name disclosed, please note "omit last name" or "omit name" after the individual's name.
Relationship to You
What is this individual's relationship to you (ex. spouse, friend, nephew, co-worker, etc.)
If the individual is in hospital or rehab, please provide the name of the hospital, room number, and phone number.
If hospitalized, when were they admitted and when are they expected to be released?
Please list details of your prayer request. (Nurse Cindy may edit information for privacy reasons before sending your request on.)
Send Prayer To . . .
Please Foward Request To
Check all that apply.
Sunday bulletin (for the congregation)
Prayer Chain (select group of Prayer Warriors)
Pastor and Pastoral Assistants
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