Request of  Visit to the Sick

Are you aware of someone who is sick at a care facility or in a home? Please let us know so that we at Good Shepherd Catholic Community can help care for them and their spiritual needs. Please complete the following information and Fr. Jonathan or Deacon Klaus will be in contact with you soon to arrange for a visit. If this is an emergency, please call the office at 817-421-1387.  Let us continue to pray for all those who are suffering from illnesses as well as their caregivers that our Lord’s grace may be upon them always.

Today's Date*
Name of person to be visited*
Location of Person*
Name of Location (if not home)
Address location of person *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Floor/Room #
Contact Number
Is the person conscious?*
Would the person like:
Pastoral Visit*
Prayer
Eucharist*
Reconciliation*
Anointing of the Sick*
Contact Person Information
Name of Contact Person*
Relationship to person*
Phone number of contact person*
Will a family member be available/present during the visit?*
Briefly describe the illness of the person if know
*