NB: Please enter your 10-digit SA cellphone number without spaces and without the +27 e.g. 0871234567
Your answer
Age *
Your answer
Language Preference *
Choose
Afrikaans
English
Ndebele
Northern Sotho
Sotho
Swazi
Tswana
Tsonga
Venda
Xhosa
Zulu
Additional Language Option (if applicable)
Please specify an addiitonal language option in which you would feel comfortable if perhaps a group co-ordinator cannot be found in your first language preference at this time.
Choose
None
Afrikaans
English
Ndebele
Northern Sotho
Sotho
Swazi
Tswana
Tsonga
Venda
Xhosa
Zulu
Where do you work? *
Name of Hospital / Unit / Clinic / Care Facility
Your answer
Suburb and City ( Health Care Facility) *
Suburb and City of Health Care Facility where you work?
Your answer
What work do you do? *
Tell us a little about your self (family, interests etc.) *
Your answer
What would you like us to pray about? *
Your answer
Do you have any other practical needs we may be able to help you with?
Your answer
Protocols and Sign-up *
I understand the protocols for HCW's and will be grateful if you can find the most appropriate group co-ordinator to pray for and support me at this time. PROTOCOLS FOR HCW's: (1) Do not feel any obligation or pressure to respond to messages unless you have the capacity to do so. (2) Feel free to message the group co-ordinator privately if you would prefer to make a more private request for prayer or support. (3) Anything shared will be treated with confidentiality. (4) If the WhatsApp group is not working for you, feel free to leave the group and perhaps try a different one. Please politely excuse yourself before leaving the group.
A copy of your responses will be emailed to the address you provided.