Lakeshore Care Request
Thank you for submitting a care request. A member of the pastoral care team will follow up within 24 hours.
About The Person Needing Care and Support
Preferred Method of Contact
Home Campus of Individual with Need
About the Need
All details of this form will be kept confidential and sensitive information will not broadly shared with LCF staff or leaders.
Which best describes the situation
Grief or Loss
Visitation (sick, hospital, home-bound, etc...)
Sexual Integrity (pornography, etc)
Counseling with a Pastor (for needs assessment, encouragement, etc)
Referral to a Counselor (external counseling)
Practical Need (Handyman, Moving Help)
Describe the Need
Write as much as needed to fully describe. Use as many lines as needed.
Location of Need
If applicable, include address
Age of Person in Need
Adult (18 or older)
Youth (17 or younger)
Source of Information
Identify the source of this information so the person following up can do so with appropriate context.
Form filled out directly by person in need
Form completed by someone the need was "told to" or who is aware of the need
Prayer card -- need submitted via in-service prayer response card
If different from the person submitting the request
Your Contact Information
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