Visitation Report (Verbatim) Format



Visitation Report #:  


Date of visitation:  

Background: In this section, the student should identify basic issues such as: age, gender, marital status, religion, family description, work, disability, diagnosis, and other pertinent information. What did you know or learn about the person?

Pastoral Plans: What pastoral plans did you have before making this visit or initiating this encounter? Who referred you to see him/her? If not a referral, what led you to the visit or experience? If you have seen the individual(s), summarize the pastoral relationship, and your plans for this particular visit. What were you feeling before the visit? What did you hope to accomplish?

Impressions / Observations: Describe the person, family, or other persons and their environment? What did the room or area feel like? What kind of non-verbal messages or cues were present? What did the appearances, impressions, and cues evoke in you?

Pastoral Conversation: In this section, recount the conversation encountered between the various parties.  Place in parenthesis (pauses, interruptions, facial expressions, sounds, actions, and other significant events in the relationship between you and others during the course of the call.  Record your prayers in full. If you have to abbreviate sections of the visit, summarize what happened in that time as accurately as possible. If much of the communication is non-verbal, try to describe what you saw, and the key messages you felt heard.  In order to protect confidentiality utilize abbreviations for individuals involved or a pseudonym.

Example: C-Chaplain; P-Patient/Client; F-Father; M-Mother; W-Wife; S-Son; D-Daughter and so forth.

Number the conversations sequentially, for example: (C1, P1, D1); (C2, P2); (C3, P3, F3, S3), i.e, Chaplain (C1) and Patient (P1), next time chaplain speaks it would be C2, etc.


C1: Hello, B. My name is S. Worth, and I am the chaplain for this area. Mary, the social worker, told me that you seemed to be having a bad day today. Mind if I sit down for a few minutes and visit with you.

P1: Glad to meet you. Yeah, sit down, but I am not sure how long I will be able to talk (grimaces in pain). I got to go home pretty soon because the van is coming to pick me up. I don’t want to go. C2: etc.

P2: etc.

(If a third party speaks next- then keep the same #s at the end. For example, if the patient’s spouse speaks here you might add “S2: stated ”.

C25: I will be back tomorrow to see how you are doing. P25: Thank you for talking with me.

Summary and Analysis

The summary and analysis are extremely important as you begin examine yourself and your ministry. Though attention will be given to the patient/client/family/member/parishioner, the intent is to assist you in your growth and development in pastoral formation, pastoral competencies and pastoral reflection.

Pastoral Reflection, Pastoral Formation

 Analys is of Person(s):

  • Describe your  impressions  of  the  person(s)  to  whom  you  are  ministering  (physically, emotionally, and spiritually).

 Analys is of Self (Self Supervision):

  • As you reflect upon the visit, what was going on inside of you, e.g., your thoughts, feelings, ?

Pastoral Formation, Pastoral Competencies, Pastoral Reflection

As a pastoral person you will be engaging persons in a variety of settings and giving attention to pastoral formation, pastoral competencies and pastoral reflection issues. The first of these relate to theological insights.

 Theological Reflection is a concept, a method and a means of discerning God’s presence and activity and to make a response that is both effective and authentic. Theological reflections surface the deeper questions about the why, who and where of God in the experiences or episodes of our lives. It is a way of doing analyses in the moment as we search for meaning, purpose and spiritual well-being.

You are asked to reflect upon your ministry experience by focusing on embedded and deliberate theology as described by Stone and Duke’s (1996) How to Think Theologically.

Embedded theologies have been described as those things that have been learned and reinforced by our environment (Stone & Duke). The truth is, we all have embedded theologies, which may include what we have been taught about God, how we worship, and possibly even small things such as how we ought to dress.

Deliberate theologies have been described as “the understanding of faith that emerges from a process of carefully reflecting upon embedded theological convictions” (p. 2). Essentially, it the opportunity for individuals to examine, question, and reflect upon what we have been taught or handed down by others.

  • What theological beliefs or concepts did you identify during your pastoral visit? (These could include the patient, clients, family members, staff, yourself, and others).
  • As you consider the theological beliefs or concepts identified during the pastoral visit, you are asked to reflect further upon your embedded and/or deliberate theology” related to these issues? Feel free to reference your faith

 Cultural, Ethnic, Psychological, Psychosocial Issues – When conducting ministry visits it is important to identify theological and spiritual issues, but also to be attentive to one’s cultural or ethnic backgrounds, as well as psychological and/or psychosocial issues.  For example, did you identify issues of abuse, denial, feelings of depression, loneliness, grief or loss, homelessness, or possibly a language barrier, etc.?

  • What are some of the cultural, ethnic, psychological and psychosocial issues you identified during the visit?



Visitation Report #:  


Date of visitation:

                                             Visitation Report                                       


I visited a patient who was a regular church member and had been hospitalized for several weeks. Religion is important for a man especially in times of sickness. The sickness effects are physical and extend to emotions, ways of thinking, and religious concepts. For many, such times of sickness becomes a spiritual crisis. Therefore, a sympathetic understanding and intervention can help provide a psychosomatic remedy. However, despite the sickness, the patient had maintained his faith.

                                                Pastoral Plans

Being a regular member, the patient had missed attending the church for two weeks. His brother notified me about the situation and referred me to him.  Therefore, before the visit, I made a brief selection from the Word of God, where I chose a comforting word with therapeutic value. I also planned to pray for him because prayer has a potent therapeutic power in hospital ministry. It also stimulates the confidence and the faith of the patient.

Before making this visit, I felt that…………for help with this assignment contact us via Email Address:

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