What is the pastoral care visit request form template?
When someone is ill, grieving, housebound or simply struggling, a visit from a pastor, priest or pastoral care volunteer can matter a great deal. But requests tend to arrive in passing after a service or by a message to whoever happens to be answering — and details like which hospital, which ward, or whether the person actually wants a visit get lost along the way.
This pastoral care request form captures what the care team needs in one place: who the visit is for, what's happening, how soon, where to go, good times and what would be welcome — prayer, Communion, a reading, or just company. Location questions change with the answer, so a hospital visit asks for the ward and a home visit asks for the address. Requests for someone else check that the person knows and would welcome the visit.
Each request is saved as a private PDF in your FileIt vault, so the care team works from the same details and there's a record of who asked for what, and when.
- Best for
- Churches, parishes and faith communities with clergy or pastoral care teams
- Filled in by
- The person themselves, a family member, friend or carer
- Time to complete
- About 3 minutes
- Includes
- Urgency, location-specific details, visit preferences and prayer list consent
Who uses a pastoral care visit request form?
- A family asking for a visit to a parent who has gone into hospital
- A housebound member requesting regular home Communion
- A neighbour letting the church know someone has been bereaved
- A hospice nurse or chaplain passing on a patient's request for a visit from their own church
- A new parent asking for a blessing visit
Questions on this pastoral care visit request form
21 questions over 3 pages · includes conditional questions, multiple pages, consent checkbox.
1 Who needs a visit
- Who is the visit for?* Me · A family member · A friend or neighbour · Someone in my care (I'm a carer, nurse or chaplain)
- Your name*
- Your phone*
- Your email
- Name of the person to visit* asked only when it applies
- Your relationship to them asked only when it applies
- Their phone asked only when it applies
- Is the person part of our church community?
2 The visit
- What's happening?* Illness · In hospital · Before or after surgery · Bereavement · End of life · Housebound · New baby · Loneliness · Family crisis · Wanting spiritual guidance
- How soon is a visit needed?* Urgently — within 24 hours · This week · Whenever convenient
- Where should we visit?* At home · In hospital · Care home or hospice · At the church · By phone or video call
- Home address* asked only when it applies
- Hospital* asked only when it applies
- Ward and bed or room number asked only when it applies
- Care home or hospice, and room* asked only when it applies
- Good times for a visit Mornings · Afternoons · Evenings · Weekends
- What would be welcome during the visit? Prayer · Holy Communion · Anointing or a blessing · A reading from Scripture · Just some company and a chat · Help with practical needs
- Anything the visitor should know?
3 Consent
- Does the person know about this request and welcome a visit?* asked only when it applies
- May we include them on the church prayer list?* Yes, by name · Yes, first name only · No — please keep this private
- Sharing with the care team*
The pastoral care visit request form, page by page
1 Who needs a visit
Who is the visit for? — me, a family member, a friend or neighbour, or someone in my care. The person asking always gives their name and phone (email optional). For anyone other than themselves, the form asks for the name of the person to visit, the relationship and the person's phone. A final question asks whether they're part of your church community.
2 The visit
What's happening? covers illness, hospital, surgery, bereavement, end of life, housebound, a new baby, loneliness, family crisis or wanting spiritual guidance, plus Other. Urgency is within 24 hours, this week or whenever convenient — choosing urgent shows a note to call emergency services if anyone is in danger and to phone the church office. Where should we visit? reveals the home address, the hospital and ward, or the care home or hospice and room as appropriate. Good times, what would be welcome during the visit, and notes for the visitor finish the page.
3 Consent
When the request is for someone else, a required question confirms they know about it and would welcome a visit. Everyone chooses whether the person may go on the prayer list — by name, first name only, or kept private — and agrees that the details are shared only with the clergy and visitors arranging the visit.
Make the template yours
- Put your church office phone number in the urgent-visit note
- Edit the list of what would be welcome to fit your tradition — for example adding confession or removing anointing
- Add your pastoral team's addresses to NotifyEmails so urgent requests are seen quickly
- Remove the prayer list question if you manage the prayer list separately with the prayer request template
- File requests in a restricted vault folder only the care team can open
Tips for a better pastoral care visit request form
- Make sure someone checks notifications every day, since urgent requests need an answer within 24 hours
- Always respect the prayer list choice, especially 'keep this private'
- Call the person asking before visiting a hospital, as patients are often discharged or moved
- Record visits made separately so you can see who hasn't been seen in a while
- Don't rely on an online form alone for emergencies — publish a phone number too
Every response becomes a PDF in your vault
Each request is saved as a PDF in the vault folder you choose, and you — plus anyone in NotifyEmails — get an email straight away. The person asking can receive a copy of their request.
The Responses table lets you filter by urgency, reason or location, so the care team can see today's urgent requests or everyone currently in hospital at a glance.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Pastoral care visit request form: frequently asked questions
Is this pastoral care request template free?
Yes. It's one of the ready-made templates in the Forms app on every FileIt account, including the free plan. Use it as it is or change any question in the designer.
Do people need a FileIt account to fill it in?
No. Anyone with the public link, or a personal invitation you send by email, can fill it in without signing up.
Can someone request a visit for another person?
Yes. Choosing a family member, friend or someone in your care asks for that person's details and confirms they know about the request and would welcome a visit.
Who sees the request?
Whoever you give access to in FileIt. Responses are saved to your private vault, and the form asks people to agree to the details being shared only with the clergy and visitors arranging the visit.
Is this suitable for emergencies?
It isn't a substitute for a phone call. Choosing 'urgent' shows a note telling people to call emergency services if anyone is in danger and to phone the church office — add your number to that note.
Can we offer Communion or anointing?
Yes. The 'What would be welcome' list includes Holy Communion, anointing or a blessing, prayer and a Scripture reading — edit it to suit your tradition.