Request for Care Home Services | Salt Spring Hospice

Request for Care Home Support

Salt Spring Hospice volunteers provide companionship and supportive visits for residents in care homes who may benefit from additional connection and presence. Please complete the form below to tell us about the client and their current situation so we can determine how best to support them. These services are offered at no cost to eligible individuals within our service area.

Who are you requesting services for?

Myself

Client/patient

Family/ Friend

Other

Name of person completing request:

Title or relationship to client:

Phone

Name of client needing support:

First name

Last name

Care Home or address:

Primary contact, if different from above:

First and last name

Relationship to client:

Phone

What type of support are you requesting for the client?

If other, please explain in detail:

Please describe anything we need to know about the client, in order to find the right fit with a volunteer

REQUEST FOR CARE HOME SUPPORT

Thank you for connecting with me today and giving me peace and better closure. What a great ending for mom. I couldn't have asked for a better hospice person to come to Mom, I felt it when you walked in her room. The only reason I felt ok leaving her.

J. Rush

Request for Care Home Support

REQUEST FOR CARE HOME SUPPORT

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