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Pastoral Care
Please let us know of someone who needs a call, visit, or more.
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Email
*
Your email
Your Name
*
The name of the person completing this form.
Your answer
Your Phone Number
*
Phone number of person completing this form. We will use this if we cannot connect with the person in need or if further information is needed.
Your answer
Person in Need
*
Name of the person who is in need of a call, visit, or more.
Your answer
Phone Number of person in need
*
Phone number of the person in need of a call, visit, or more.
Your answer
Email of person in need
*
Email address of the person in need of a call, visit, or more.
Your answer
Reason
*
Brief explanation of what/why the person is in need of a call, visit, or more.
Your answer
Need
*
What is this person in need of
Call
Visit
A Meal
Connecting to Resources
Other:
Required
Mishebeirach List
*
Does the person wish to be added to the Mishebeirach List which is read during Shabbat Morning services along with a prayer for healing? The name listed may be in Hebrew or English.
Yes (if yes, please list name in next question)
No
Name to be Read
If the person would like to be added to the Mishebeirach List, please give the name they prefer in either Hebrew (transliteration) or English.
Your answer
Other Needs
Please tell us anything else this person may need at this time that we may be able to assist with.
Your answer
Your Preference
*
May we tell the person in need that you have shared their information with us?
Yes
No, I would prefer to remain anonymous
A copy of your responses will be emailed to the address you provided.
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