Prayer Request Date Name * First Name Last Name Email Request * May we release your information to the WHCC Family/Intercessors? * Yes No May we publicly pray for this request at a church service? * Yes No Illness & Hospitalization Information Nature of Illness: * Hospital or Surgery Center: If applicable, DATE and TIME of Surgery: Is this outpatient surgery? Yes No Do you request a Pastor or Church Representative be present for Surgery? Yes No Signature * Please type your full name Thank you for sending your prayer request!
