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
Need & Assistance Fund (over 18 years old)
Pediatric Care Fund
Technology for Hope
I am the
Family Member/Caregiver of the Patient
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
avoid disconnection of utilities
prevent or delay eviction or loss of home
assist with funeral expenses
allow for construction of ramps or other home improvements necessary for accessibility
increase quality of life by providing a child with a wish trip
The patient's name is: (person who received assistance)
If we use your testimonial, we will NOT disclose the patients name or personal information
Please briefly describe what the Foundation provided to the patient/family
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"
How satisfied were you/the family with the application/assistance process
Do you have any feedback for the application/assistance process
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.
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