Client case notes

Client case notes will be submitted to Howie Square. Please give him a call at (212) 260-6200 if you have any questions.

Prefer to print the form and bring it to the office?

Date *

Start time *

End time *

Client name *

Volunteer/student name *

Nature of activity *

Mobility aids used (if any)

Physical condition *

Apartment condition *

Client's emotional state/mood *

Overall experience and additional comments *

Signature *

Friendly visiting

Health & wellness

Special occasions

Telephone reassurance

Therapeutic walking

Client case notes

Volunteer quotes

3 Washington Square Village, Suite 1F
New York, NY 10012
(212) 260-6200

info@visitingneighbors.org