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Sick and Shut-in Virtual Visitation Request

"Is any sick among you? Let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord: And the prayer of faith shall save the sick, and the Lord shall raise him up." James 5:14-15.

On behalf of Dr. Carson and the R.O.C.K. family, we extend our prayers to you and your family during this time of illness. Caring for our Partners is the heart of our Apostle and the Partner's Care Ministry. It is our desire to provide loving care to all our Partners. If you would like a visit from one of our R.O.C.K. leaders or ministry volunteers, please complete this form.

Your name *

Last name

Email address *

Preferred Method of Contact *

Phone

Email

Text

Facebook

Twitter

Instagram

Phone Number

Phone type

If a Social Media option (Facebook, Twitter, Instagram) selected as preferred method of contact, please specify handle.

Preferred Time of Contact *

Morning

Afternoon

Evening

When would you like to receive a visit? (First Choice) *

First Choice Date - Preferred time of day for visit? *

9am - 11am

11am - 1pm

1pm - 3pm

3pm - 5pm

5pm - 7pm

7pm - 9pm

When would you like to receive a visit? (Second Choice) *

Second Choice Date - Preferred time of day for visit? *

(Check all options you are available)

9am - 11am

11am - 1pm

1pm - 3pm

3pm - 5pm

5pm-7pm

7pm - 9pm

Details *

Please provide name of location (hospital, subdivision, apartment complex), and address. Also, please specify information on your sickness.

How long do you expect your recovery period to be? *

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