Hospice Bereavement Services Family Contact & Data Request Form

Streamline Bereavement Support with Compassionate Data Access Forms

Coordinating bereavement services for grieving families requires sensitivity, organization, and secure data management. This Hospice Bereavement Services Family Contact & Data Request Form helps hospice care providers, social workers, and bereavement coordinators gather essential family contact information while respecting privacy and ensuring appropriate follow-up support.

Why Use This Form for Bereavement Services?

After the loss of a loved one, families need timely access to grief counseling, memorial event information, and ongoing support resources. This form template enables your bereavement team to:

• Collect accurate family contact details for grief counseling outreach and support coordination
• Understand specific needs including preferred communication methods and support service interests
• Manage consent for ongoing bereavement communications and memorial event invitations
• Document data access requirements for internal staff coordinating multi-faceted support services
• Maintain compliance with healthcare privacy standards while providing compassionate care

Perfect for Healthcare and Hospice Organizations

This template is designed for hospice providers, palliative care programs, healthcare facilities, bereavement coordinators, and social workers who manage ongoing family support after patient loss. The form captures relationship details, contact preferences, and specific bereavement service needs in a respectful, organized format.

With conditional logic built in, the form adapts based on the type of services requested—whether that's individual grief counseling, group support sessions, memorial event participation, or educational resource provision. This ensures families receive personalized follow-up without overwhelming them during a difficult time.

Automate Follow-Up with Stepper

Connect this form to Stepper to automatically route family information to the appropriate bereavement coordinators, schedule follow-up communications, send memorial event invitations, and update your patient management system with family contact preferences. Automation ensures no family falls through the cracks during their grief journey.

Secure, Compliant, and Compassionate

Built on Paperform's SOC 2 Type II compliant platform, this template helps you maintain secure family data while providing the warm, supportive experience grieving families deserve. Customize the form's appearance, add your hospice branding, and create a professional touchpoint that honors both the deceased and their loved ones.