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List of Prayers for Healing
Please verify reCaptcha before submitting the form.
Submission Form for our List of Prayers for Healing/
R'fuah Sh'leimah
If you would like our community to keep you or a loved one in our thoughts and prayers this Shabbat, please fill out the form below.
Names will be kept on the Healing List for one month (30 days) unless indicated otherwise below.
All information provided on this submission will be kept confidential except for the name of the person in need of prayer unless indicated otherwise.
These names will be read to the community by the Rabbi during the healing prayer and printed in the weekly newsletter.
*
I would like to:
Please Select One
Add A Name to The Healing List
Remove A Name from the Healing List
Change The Information For A Name Currently On the Healing List
*
Are You A Current Member?
Please Select One
I Am A Current Member In Good Standing
I Am Not a Current Member
I Am Not A Current Member But Would Like to Hear More About Membership Opportunities.
Our prayers are welcome to all and do not require membership to submit a name.
*
Please enter today's date
Removal Date, Automatically after 30 Days, From the Submission Date Unless Otherwise Requested Below.
If submitting a request for more than one month, please provide a brief explanation for the extended request.
*
Please Enter Your First Name Here
*
Please Enter Your Last Name Here
*
Please Enter Your Phone Number
*
Please Enter Your Email Address
*
Would you like to be contacted regarding this submission?
Please Select One
No, there is no need to contact me regarding this submission.
Yes, please have the Rabbi contact me regarding this submission.
Yes, please have Temple Staff contact me regarding this submission.
*
I Would Like For This Request To Remain Private And Not Shared With The Congregation.
Please Select One
No
Yes
*
This Prayer Request Is For:
Please Select One
Myself
Someone Else
*
Please Enter The Full Name Of The Individual To Add To The Healing List
*
If Requesting A Prayer For Someone Else, Who Is This Person To You?
Please Select One
Myself
Spouse / Partner
Child
Parent
Sibling
Grandparent
Grandchild
Friend
Other Relative
*
Does The Person In Need Of Prayer Wish To Be Contacted?
Please Select One
No, please do not contact the person in need of prayer.
Yes, please have the Rabbi contact the individual being added to the Healing List directly.
Yes, please have the Temple Staff contact the person in need of prayers.
*
If Yes, To Previous Question, Please Provide The Email Address Or Phone Number Of The Person You have Requested To Be Added to this List. If This Does Not Apply, Please Put N/A.
Is There Any Additional Information That You Would Like To Share With Us?
Sun, September 24 2023 9 Tishrei 5784