Our Lady of Good Counsel - Prayer Requests

Name of ill/disabled person
Phone Number (numbers only)
Your name
Phone Number (numbers only)

Have you received permission from this person to be put on a prayer list?

Yes No

Would you like this person to: (check all that apply)

Be placed on the prayer list read at Mass
Be placed on the prayer list in The Counsellor
Be visited by a pastoral staff member
Be able to receive Communion while in the hospital

Date Admitted / / (format: MM/DD/YY)
Hospital

Receive Anointing of the Sick
Receive follow-up calls from the Parishioner Support Ministry

If you wish to provide additional information, please do so in the space below:

Due to changes in our server, we are currently unable to accept forms submitted through the website. Please contact the parish office at 734.453.0326 with your requests. We hope to be able to restore the website forms in the near future.