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? Yes No Not at this time. Please contact me at a later date When would you like us to contact you? Who would you like to schedule the In-Service for? Faculty & Staff Residents of the facility & family Staff & residents of our facility Residents only Nursing Staff Only Universal workers only Kitchen staff only Families of Residents only Any and All interested Mandatory Staff meeting only Other (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 Services Above & Beyond Home Health Services - General Topics Above & Beyond Hospice Services - General Topics "Nutrition at End of Life" Hospice Case Manager Nursing Facility and Hospice Collaborative Training The Dying Process: Solutions for Challenges in Supporting Residents and Their Families Do you have a specific date and time that would work best? MM slash DD slash YYYY : Hours Minutes AM PM AM/PM Would you be interested in Above & Beyond providing Refreshments for your in-service? Yes No What type of Refreshments would be enjoyed by the audience of the In-Service? Breakfast Items Light Lunch Afternoon Snacks Evening meal Desserts Dietary restrictions or recommendations:Name of person submitting this form* First Last Phone number of person submitting this form*Email 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?* Yes No Who 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?