Palliative Care Survey Palliative Care Survey Subscribe What is the name of your parish?What role do you have at your parish? Parishioner Member of a parish Ministry to the sick Parish AdministrationWhat is the name of your Ministry, or your role in Parish Administration:Who does your parish or ministry support? Patients in hospitals Hospice People in nursing or assisted living homes People who are homebound Caregivers People suffering from specific illnesses (please specify below what illness) Other (please specify below) None of the aboveAdditional detailsWhat service does this parish or ministry provide? Bringing Holy Communion to person Visiting & praying with person Helping with meals Helping with taking care of things around the house Transportation Services Bereavement & funeral support Support group for specific condition (please specify below which condition) Other services (please specify below) None of the aboveAdditional detailsWithin the definition of Palliative Care, are there any other areas of need that are not currently being addressed by your parish or the Diocese? Yes No Not SurePlease list those needs that are not currently addressed:Are you aware of palliative medical specialists/providers, hospice, nursing home, or home care providers, in your area who follow the Catholic Church's teachings (even if they are not Catholic themselves)? Yes No Not SurePlease provide any information you have on these Palliative Care providers:How can the Diocese of Arlington help you in your ministry? Provide more informational resources and brochures Offer training for those who visit the sick Be a central point-of-contact for all parish liaisons related to Palliative Care ministries Help parishes set up a "Lending Closet" for medical and other equipment Other (please specify your need) UnsureAdditional detailsEmailOPTIONAL: Would you be willing to provide your contact information to stay informed about palliative care initiatives within the diocese? Yes NoFirst NameLast NameAddressAddress Line 1Address Line 2CityStateZip CodePhone/MobileSubmit Form [email-subscribers-form id=”2″]
