Facility Sign Up

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What we need from you:

HIPAA Forms

In order to verify that we will not release any private information about our clients, we will need your HIPAA forms that our volunteers are legally required to sign.

Time Block Hours

In order to schedule volunteer sessions, we need what times are available for each patient. In the volunteer form below we will will give you the ability to specify times from 10:00AM to 7:00PM.

Client Bio’s

In order to ensure we are getting the most engaging volunteer-client relationship, we would like you to provide short bios about each client that name some likes or dislikes that can help start conversation. No names should be specified in order to adhere to HIPAA regulations.

Facility Sign-Up Form

In the form below, you will be able to fill out all the necessary information outlined above.

Facility Form