Mi Shebairach Form

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Shalom. If you or a loved one or friend is ill and would like to be included in our Mi Shebairach prayers for a complete and speedy recovery, please complete the information below. We wish you a refuah sheleimah.

* Your First Name (person completing the form)

* Your Last Name (person completing the form)

* First Name of ill/injured person

* Last Name of ill/injured person

Email Contact

Hebrew Name

Nature of Illness/Condition (You are not required to share details on this form.)

* Onset of the illness/condition

Notes regarding condition and activities (i.e. in physical therapy 1-2 times per week; unable to walk; using feeding tube; etc.)

* Would you like Rabbi Kaiman to reach out via phone or a personal visit?

Who should be contacted?

What's the best phone #?

* Where are you currently located?

Notes regarding location (i.e. which hospital/facility; address and room number; in hospital until a specific date, etc.)

* Are you open to other community members visiting or calling?

Is there anything else you'd like to share with us?

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Our Adult Ed. Programming includes a variety of ongoing series such as Ready or Not: Jewish Perspectives on End-of-Life Issues, Scientists in Synagogues and Synagogue Scholars & Authors Series!

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