Request a Hospital Visit

If either you or a friend or a member of your family is in hospital and would like to be visited by either a Jewish Hospital chaplain or a Jewish Visitor, please complete the form below.

Our chaplains and visitors come from all the different parts of the Jewish community.

Request a Hospital visit online

Name of Patient

Name of Hospital

Ward (if known)

Your Email (required)

Are they in an intensive care unit?
 Yes No

Does the person have an infectious disease?
 Yes No

How long are they likely to be in hospital, if this is known?

Would the patient like to be visited by
A Jewish Hospital Chaplain:  Yes No
A Jewish Hospital Visitor:  Yes No
Their own Rabbi (if he/she is a member of a specific synagogue):  Yes No
If yes, please tell us the name of the synagogue so we can get in touch with them and request a visit:

Any other information you would like to give us about the patient e.g. their age, their general state of health, whether they have family or friends who visit. This is not in any way to intrude and you do not have to give us any information at all but it can sometimes help if the chaplain and/or visitor has some knowledge of the patient before they visit.

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