Visit Note - St. Louis

From this page, active volunteers can view and complete an on-line Volunteer Visit Note. The completed form will be submitted to the appropriate Volunteer Coordinator for processing. Please remember to submit your notes within 24 hours after your visit is made to ensure compliance.

If you are unable to use on-line reporting, you may still print a Volunteer Visit Note. Please be sure to submit your completed note within 24 hours of your visit using the postage-paid envelopes that we have provided. If you are in need of more envelopes, please contact your Volunteer Coordinator.

Patient Name *

Office Location

ST. LOUIS (for other locations click here)

Visit Date *

Time In *

Time Out *

Direct Services Provided

Describe services provided and patient/caregiver response.

Answering Phones

Companionship

Emotional Support

Errands

Food Preparation

Household Chores

Massage Therapy

Pet Therapy

Respite Care

Special Project

Spiritual Support

Telephone Call

Tuck-In

Veteran to Veteran

Other: (please specify)

Additional Comments: (This might include specific statements the patient or caregiver made)

Administrative Services Provided

Describe tasks and projects completed in the office.

Filing/Scanning

Paperwork

Administrative Task

Other: (please specify)

Volunteer e-Signature *

VC Initials

Disclaimer: This form will send your message to Comfort Hospice as an email. Because e-mail sent to and from this site may not be secure, you should take special care in deciding what information you send via e-mail to us.