Volunteer Contact Log

Cortland: 11 Kennedy Parkway Cortland 13045 Tompkins: 172 E. King Rd Ithaca 14850

Telephone: 607-272-0212 Fax: 607-272-0237
Patient Name
Date of Contact

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Volunteer Name
Location of patient:
Reason for visit:
Time of beginning of visit until time of end of visit, including a.m. or p.m.
Comments:
Volunteer signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Call with any situation that requires immediate attention, 272-0212 Submit this contact report online within a week of the visit
Should be Empty: