Outdoor Resident Visit Request Form - Village Square
To be used during Step 2 and Step 3 of facility reopening plan.
Visitor Name
*
Only two visitors per one patient at a time
Phone Number
*
Resident Name
*
Appointment
Resident Room Number
*
Are we celebrating anything special during the visit?
i.e. Birthday, anniversary, etc.
Schedule a Resident Visit
You will receive a call to confirm your time and date requested.
Should be Empty: