St. Francis Cares

Non-Urgent Pastoral Care Request Form

Please be as detailed as possible in your responses. If your situation is urgent, please contact the Parish Office directly at 904-615-2130. If you are experiencing a mental health emergency, you can call National Alliance on Mental Illness Helpline at 1-800-950-6264 or text “NAMI” to 62640 to reach a crisis counselor or call the National Suicide Prevention Lifeline at 1-800-273-8255. Please call 911 if you are in immediate danger.

Your Name (person filling out the form):

First Name

Last Name

Your Relationship to the Person in Need of Care:

Care Recipient's Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best Contact Number for Care Recipient:

(###)

###

####

May we leave a voicemail at this number?

Yes

May we text this number?

Yes

Circumstance:

Request:

Receive Holy Communion from a Eucharistic Minister

Receive a social/prayerful visit or phone call from a Shepherd

Any other information to assist (examples: difficulty hearing, etc.)

St. Francis Cares

Non-Urgent Pastoral Care Request Form

© st. francis in-the-Field

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