As Christians we are called to care for one another – physically, emotionally, and spiritually. By completing this form, you are letting us know of a care need in your life. Thank you for sharing this information with us, allowing us to join you in your journey.

You will be contacted to confirm that your request has been received and to gather any additional information that might be needed. We will do our best to respond within 24-48 hours, however, if you have an urgent need, please contact Becki Bork, Care Director (614-451-3736 or bbork@ualc.org). In the event of an after-hours emergency care need, please call the main church number (614-451-3736) and select option #2 and you will be connected to the On-Call Pastor.

Please select all that apply. *

Care

Funeral

Counseling

LifeWalk

First Name *

Last Name *

Best Contact Phone *

Email Address *

Preferred contact method? *

Phone

Email

Care Need

Patient Name *

Name of Hospital *

Currently In-patient? *

Yes

No

Date of Surgery * +

Reason for Hospitalization/Surgery *

Permission to include in Public Prayer *

Yes

No

Your relationship to patient *

Self

Spouse

Adult Child

Other Other

Funeral Need

I need to: *

Schedule Service

Request Pre-planning Information Packet

Name of Deceased *

Someone from staff will contact you within 24 hours to discuss details.

Please provide us with the address where the packet will be sent.

Street Address *

City *

State *

Zip Code *

Counseling Need

Referral for which type of counseling? *

Individual (Adult)

Individual (Child)

Couples

Family

Brief description of reason for counseling (all information shared will remain confidential) *

LIFEwalk

LIFEwalk is intended as short-term care as people journey through challenging
seasons and situations, and a bridge to connecting them to the church community.
LIFEwalk is a Bible-based prayer ministry. It is NOT counseling. LIFEwalk Prayer
Ministers are trained to practice good listening and prayerful encouragement.

I'd like to request a LIFEwalk team *

Yes