Episcopal Diocese of Virginia
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Submit a Prayer Request

(* Denotes Required Fields)

Please complete the following information.

Name of person for whom prayers are requested: First and last name *
Reason (please check appropriate box): 
If Hospitalization and/or Surgery, please provide the date(s) and name of hospital:
If "other reason," please tell us more below:
Departure & return dates (for travel prayer requests only):
The person we will be praying for is: 
If parishioner's family, what is relationship?
Should we include the prayer request in the Sunday bulletin insert? 
If yes, how long should the prayer request be in the Sunday bulletin? 
If more than two weeks, please explain:
Your name: *
Your email: *

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