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Grace Note Singers Bedside Singing Request
Please call us at 401-400-0359 with your request or fill out this online form as completely as you are able. The purpose of this form is to guide us in providing you with a bedside singing experience that meets your needs. We look forward to being in touch with you and sharing our voices with you and your loved one.
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Primary Care Giver Information
(Main Contact for Bedside Sing)
Full Name
*
Your answer
Relationship to Patient
*
Your answer
Best Phone Number
*
Your answer
Second Phone Number
Your answer
Email
Your answer
Patient Information
Full Name
*
Your answer
Age
*
Your answer
Current Address (Street, City, State Zip)
*
Your answer
Any spiritual beliefs or practices of which we should be aware?
*
Your answer
What can you share with us about the person we'll be singing for (joys, work, family, mood) to help us in choosing songs to share.
*
Your answer
Physical Space
Description of physical space
*
Your answer
Who else might be present?
*
Your answer
Request Information
How many singers would you like?
*
We usually come in groups of 4-6, but will do our best to adjust to your wishes
Your answer
Preferred date of sing?
Your answer
Preferred time for sing? (morning, afternoon, evening)
Your answer
Duration of sing? (10-20 minutes is typical)
Your answer
Are there any cats or dogs that might be present?
*
If so, please list how many.
Your answer
Additional comments or concerns
Your answer
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