Outreach Services

When a cancer patient, amputee, or individual dealing with a serious medical condition is referred to the Outreach of Hope, several avenues of ministry are available. Please select the services you feel would best meet you or your friend's needs and complete both sections of this form. We are unable to send materials without all of the mailing information. Outreach of Hope materials are only available in English at this time, therefore we do not send resources outside the US and Canada.

Make a donation to help the Outreach of Hope provide encouraging resources.

Referral Form


Pray for needs as described below Provide address so we can send prayer card  

Send Complimentary Do Not Lose Heart faith based resources addressing spiritual and emotional issues of suffering - (Resources are not shipped outside the US and Canada).  
  Fields with an * required for submission
* Person Being Referred (full name)  
* Phone  
* E-Mail Address  
* Address Line 1  
Address Line 2  
* City  
* State  
* ZipCode  
Country  
Age  
* Type of Cancer/Amputation or Medical Condition  
Religious Affiliation (if any)  
Family Mambers and Ages  
Prayer Needs (if known) :  
Helpful Information or Remarks  
  Information below pertains to person submitting the request. If this information is not completed with your contact information, your request will not be processed.
* Referral (Your) Name  
* Relationship to Patient  
* Referral Phone  
* E-mail (Your)Address  
* Confirm E-Mail address  
* Referral (Your) Address  
* City  
* State  
* ZipCode  
* How did you find us?  
  IMPORTANT INFORMATION-Due to the high number of referrals, your request may take up to two weeks to process.