Congregational Care Form

First name*

Last name*

Phone*

Other Information

Name of the Contact Person*

Person to contact if unable to reach the person receiving care.

Contact's Mobile Phone*

Type of Facility*

Hospital

Rehabilitation

Long-Term/Nursing Home

Hospice - Home

Hospice - Facility

Homebound

Sick at Home

Other

If Other, please list

Name of the Facility (Hospital, Nursing Home, Rehab)*

Name of the Person submitting this report. (if different from the person receiving care or the contact person)*

Best Time of Day for Visit*

Morning

Afternoon

Evening

You will receive a call to confirm the time.

Additional information

Shiloh Baptist Church (New Site)

Contact Us

Phone:
540-371-1153

Mailing Address:
Shiloh Baptist Church (New Site)
P.O. Box 93
Fredericksburg, VA 22404

Visit Us

Sunday Mornings at
10:00 AM

525 Princess Anne Street, Fredericksburg, VA 22401

Links

Forms

Social Media

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