Please submit this form after each conversation with client/caller or 3rd unsuccessful attempt to make contact. Click here for PDF version.
Mentoring Date:
Your Name (required):
Phone:
Your Email (required):
Client Information:
Client/Caller's Name:
Best Time(s) to Call:
Client Email:
Prefers to be contacted by:
Email communication is acceptable, but communicating by telephone is a more effective form of mentoring. If possible, try to set up a phone appointment with the person you are mentoring.
Name(s) of loved One(s):
Relationship / Age(s):
Air Carrier / Flight Number:
Call / Email Log:
Date / Time:
Attempted Contact by: PhoneEmail
Notes:
Date/Time:
Summary of Client / Caller's Response
Thoughts / Feelings:
What was the focus of the call?
His/Her available support systems:
Your Assessment: Doing as well as can be expected Concerned about his/her mental state (if so, explain below)
Additional Comments or Concerns:
Your Next Step: Follow up callFollow up email To be made on:
Information / Referral Requested (explain):
Thank you for being a Volunteer Grief Mentor. You are the heart of ACCESS!
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You may also fill out this form and mail it in.
Book proceeds benefit ACCESS Purchase Here
Volunteer Grief Mentor Training & Retreat at Joan Lunden's Camp Reveille
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