Lutheran Church of Hope - West Des Moines: Home: Hospital Visitation Request

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Hospital Visitation Request Members of the hospital visitation team make daily visits to DesMoines area hospitals to offer support, encouragement and prayer. Please fill out the form below or call us at 515-222-1520 to schedule a visit. Please do not rely on the hospital to notify the church, as frequently Hope is not notified or is notified after your release * Required First Name * Last Name * Email Address * Home Phone ( ) - ext. Mobile Phone ( ) - ext. Ptients Legal Name * Patients goes by name Does the patient attend Lutheran Church of Hope? * Yes No If no, please indicate how and why visit is needed Has the patient agreed to be visited by Lutheran Church of Hope * Yes No Date entering hospital * Name of Des Moines area hospital * Can this information be added to the weekly prayer bulletin? * Yes No Does the patient want someone to try and call to pray with them, prior to hospitalization? * Yes No Comments Thank you for filling the information out, someone from the Care Team will be in contact with you. Last Published: June 8, 2009 12:09 PM
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