Referring a Friend

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

Referral Form


Pray for needs as described below Provide address so we can send prayer card  
Send complimentary Endurance Resources
Contains books addressing spiritual and emotional issues of suffering (Resources are not shipped outside the U.S.)  
  Fields with an * required for submission
Person Being Referred (full name)  
* Phone  
E-Mail Address  
* Address Line 1  
Address Line 2  
* City  
* State  
* ZipCode  
Age  
* Type of Cancer/Amputation or Medical Condition  
Religious Affiliation (if any)  
Type of Current Treatment  
Family Members and Ages  
Prayer Needs (if known)  
  Information below pertains to person referring the patient
* Referral Name  
Relationship to Patient  
Referral Phone Number  
* E-Mail Address  
Referral Address  
City  
State  
ZipCode  
Helpful Information or Remarks  
How did you hear about us?  
 
The image below ONLY contains letters.


* Letters in image: