In-Service Scheduling Request Want to tell someone else that we provide in-services? Just click here to send them an email. As a community service, we offer presentations, often called "in-services", on a variety of topics related to Home Health Care, Hospice Care, Therapies and other subjects. We would love to do this for a group or facility that you are associated with too! Please complete this In-Service Scheduling Request Form and we'll be in touch with you promptly to schedule your event. We can even provide snacks and refreshments for those who attend the event! Are you interested in scheduling a free educational in-service for your facility?YesNoNot at this time. Please contact me at a later dateWhen would you like us to contact you?Who would you like to schedule the In-Service for?Faculty & StaffResidents of the facility & familyStaff & residents of our facilityResidents onlyNursing Staff OnlyUniversal workers onlyKitchen staff onlyFamilies of Residents onlyAny and All interestedMandatory Staff meeting onlyOther (please specify)For whom would you like the in-service to be scheduled?What topic would you like to schedule an In-Service about?"Good Grief" Hospice Bereavement Coordinator"New Rules of End of Life Care" Hospice Coordinator"Sit & Get Fit Exercises" Physical Therapy or Occupational Therapy - Home Health ServicesAbove & Beyond Home Health Services - General TopicsAbove & Beyond Hospice Services - General Topics"Nutrition at End of Life" Hospice Case ManagerWhat month will you be interested in scheduling in 2017?JulyAugustSeptemberOctoberNovemberDecemberDo you have a specific date and time that would work best? : HH MM AM PM Would you be interested in Above & Beyond providing Refreshments for your in-service?YesNoWhat type of Refreshments would be enjoyed by the audience of the In-Service?Breakfast ItemsLight LunchAfternoon SnacksEvening mealDessertsDietary restrictions or recommendations:Name of person submitting this form First Last Phone number of person submitting this formEmail of person submitting this form Will the person submitting this form be the same as the person who is the contact person for this In-Service?YesNoWho is the contact for confirming this In-service? First Last What is the contact person's phone number?What is the contact person's email address? Please check the box below to help us prevent form-submission spam. Thank you!