Assistance Testimonials
Please use this forum to express the impact the foundation was able to have on the patients/families life with the assistance provided.
Please select the type of assistance you received from the Hospice & Palliative Care Foundation *
I am the *
Please indicate how the funds provided by HPCF will meet this individual’s/families’ critical needs: *
Please select the option that is most appropriate, or chose the other box and briefly explain the impact
The patient's name is: (person who received assistance) *
If we use your testimonial, we will NOT disclose the patients name or personal information
Your answer
Please briefly describe what the Foundation provided to the patient/family *
Your answer
Please provide a detailed testimonial explaining how this assistance provided by the Foundation benefited/assisted the patient/family, (WE OFTEN USE THESE FOR GRANT AND FUNDRAISING PURPOSES SO PLEASE PROVIDE DETAIL ON HOW/WHY HPCF PROVIDING ASSISANCE WAS SO HELPFUL AND IMPACTFUL) These testimonials allow us to continue providing these services to your patients so we appreciate you taking the time to provide a great testimonial. *
this can be a quote/testimonial from the family or from the healthcare professional. *WE WILL NEVER USE A PATIENTS NAME IN A TESTIMONIAL- IF YOU INCLUDE A NAME AND WE USE THE TESTIMONIAL, THE NAME WILL BE REPLACED WITH "A PATIENT"
Your answer
How satisfied were you/the family with the application/assistance process *
Extremely Unsatisfied
Extremely Satisfied
Do you have any feedback for the application/assistance process
Your answer
Any information you submit, (EXCLUDING YOUR NAME) can be used at the discretion of the Hospice & Palliative Care Foundation for circumstances including but not limited to: marketing, grants, and testimonials.
Never submit passwords through Google Forms.
This form was created inside of Hospice and PalIative Care Foundation. Report Abuse