Tell us about a special moment as a
Hospice of Michigan Volunteer

Note:  All stories will be reviewed by the Volunteer Services Department and may be amended to protect the privacy of the patients and families we serve.

*denotes required field

Volunteer Moments

Date *

Your First Name *

Your Last Name *

Location/Office * --Please select-- Alpena Ann Arbor Big Rapids Bloomfield Hills Cadillac Clinton Twp Detroit Fremont Gaylord Grand Rapids Ludington Muskegon Saginaw Southfield Traverse City West Branch

Tell Us Your Special Story

May we share your story with other Hospice of Michigan volunteers? *

Yes

No

May we identify you as a Hospice of Michigan volunteer and potentially share your story in Hospice of Michigan advertising or social media? *

Yes

No

Clicking "Yes" and filling out the accompanying form serves as consent for
Hospice of Michigan to use your story as described.

Phone Number

Address

City

State

ZIP or Postal Code

Checkboxes

ALL

News Coverage

TV, Print or Radio Advertising

Printed Materials

Direct Mail

Fundraising

Internal/External Web Site

HOM Social Media (Facebook, e.g.)

Is the patient and/or family willing to be identified and share their story of this experience in Hospice of Michigan advertising or social media? *

Yes

No

Don't Know

For a printable usage consent form, click here.