Request Prayer

As we grow in love and care of one another at The Center, we want to respond to your personal concerns and celebrations as they arise in your life.

Please use the form below to communicate your prayers requests with us.

Submitted By:

First

Last

Leave blank if you wish to remain anonymous

On Behalf Of:

First

Last

Leave blank if you wish to remain anonymous

Your Email

Is this request a: *

Please tell us about it: *

If this is a medical procedure, is it in-patient or out-patient?

If a hospital stay is involved, which hospital?

Please identify the hospital location, for example, Medical Center, Memorial City, West, etc.

If you are the patient, who is the point of contact/caregiver?

Please list name, relationship and phone number

May we be in contact with them if needed?

How would you like to be contacted? Check all that apply.

Preferred Phone Number

Who can we share this with? *

Please check all that apply.

May we place you on The Center’s prayer list?

It is emailed weekly to those who have opted-in to receive it and pray.

Is there anything else you would like for Pastor Rachel to know?

11140 Greenbay St.
Houston, TX 77024
(713) 465-3467

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