Care Request Form

As members of the Curtis Lake Cares Team, our goal is to help connect you with the people and resources you need during your time of need. We also want you to know that our team prays over each individual and request that comes through our system!

indicates a required field

First Name

Last Name

Phone Number

Please provide either your best contact phone number or email address so that our team can get in touch with you.

Area of Need

In which area of care are you looking for help?

Grief (Loss of a loved one) Divorce Care Visitation (Hospital or Homebound) Transportation (ride to an appointment or church) PrimeTime Connection (55+ Community) Foster/Adoptive Support Marriage Support Unexpected Life Event A Listening Ear (We are not certified counselors, but are happy to listen and pray with you).

Please share a few details about your situation.

Follow Up

Please let us know how you would prefer your follow-up be delivered. Please ensure we have the information for the communication form you select.

Phone Call Text Message Email