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.

Primary Care Giver Information
(Main Contact for Bedside Sing)
Full Name *
Relationship to Patient *
Best Phone Number *
Second Phone Number
Email
Patient Information
Full Name *
Age *
Current Address (Street, City, State Zip) *
Any spiritual beliefs or practices of which we should be aware? *
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. *
Physical Space
Description of physical space *
Who else might be present? *
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
Preferred date of sing?
Preferred time for sing? (morning, afternoon, evening)
Duration of sing? (10-20 minutes is typical)
Are there any cats or dogs that might be present? *
If so, please list how many.
Additional comments or concerns
Submit
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