Pastor Contact Form

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Pastor Contact Form

If you are in the hospital or sick, and wish for contact of a pastor, please fill out the form below and a pastor will be in contact with you as soon as possible. This form is confidential, only the pastors of the church will be able to see your replies. The information shared on this form will only be shared if you first give permission to do so.

Please be sure to share this form with close family or friends who may help you in medical situations if you are unable to submit the form yourself. Remember, you can always call the church office at 610-285-6157.

Name *

Phone number *

Please share the reason for needing a pastoral contact or visit. *

I am currently in the hospital and would like pastoral phone call or visit.

A family member is currently in the hospital and would like pastoral phone call or visit.

I am having surgery, or had surgery, and will need help

A family member is having surgery, or had surgery, and will need help.

I would like to discuss marriage counseling, family support, etc.

I would like my. name or a family member's name added to the prayer request list in the church bulletin and newsletter.

Other:

Required

If you, or a family member, are in a hospital, which hospital are you in?

Which pastor would you like to reach out to you? *

Lutheran

UCC

Either

Message to the pastor:

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