Make an Appointment — ALS Family of Faith

Schedule a Time to Connect

Whether you have received an ALS diagnosis, you are the family member of someone who has, or you are a caregiver, we are here to walk with you through this challenging season.

When you complete this form, we will connect you with one of our Care Partners who has been trained to come alongside you through this life chapter. Whether you need a listening ear, prayer, guidance, or a shoulder to cry on, consider us a part of your family. It is our privilege to walk together with you through the journey ahead.

To get connected with a Care Partner, please complete the form below and we’ll be in touch shortly.

Name

First Name

Last Name

Phone

(###)

###

####

Preferred method of contact

State

Select your state.

In what way have you been impacted by ALS?

Select all that apply.

I have been diagnosed with ALS

My family member has been diagnosed with ALS

I am a caregiver for someone who has been diagnosed with ALS

Other

Do you have a gender preference for the individual with whom you are paired?

Additional comments

If you have additional information about your circumstances that would better help us pair you with the proper individual, please add that here.

How can we pray for you?

Optional space for you to submit a prayer request for us to post on familyoffaith.center/prayer

How did you hear about us?

If you selected 'other' above, please specify here:

Secondary Contact Info

Please provide the phone and/or email address for a secondary contact.