Active Volunteers


Volunteer Service Activity Report


 
Visit Date * 		 
Select Office Name *
 
Patient Initials * 		 
Patient I.D. *
 
Time In: (am:pm) *
Length of Visit

Total Travel Time
Total Mileage
 
Type of Contact *

Section A


Type of service Description
Sit with patient for short periods of time while caregiver goes to church, shopping, appointments, etc.
Read aloud, write letters, life review, play cards, play games or music, organize photo albums or papers, watch TV or movies, bird watch, take dictation, puzzles, crafts, etc.
Grief support.

Other - If other please describe type of services needed

Section B


Describe Visit Activities
Please assure information is accurate.

Using the Submit button constitutes an electronic signature.
Volunteer Name *   



*  Indicates a required field

Need Help?

United Hospice is happy to answer any questions you have, provide our locations in the Southeast, and assist you with your needs related to transitioning the care of a loved one.

  • Call (770) 279-6200
  • Toll Free (800) 443-4788
  • Contact Us

Resources

Helpful information on Pallitative Care, Grieving and Professional Hospice.