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Patio and garden visit booking form
All requests will be subject to confirmation via phone call
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* Indicates required question
Your name and surname
*
Your answer
Name of the resident you will be visiting
*
Your answer
Your email address
*
Your answer
Your cellphone number
*
Your answer
Date of requested visit *
*
MM
/
DD
/
YYYY
Time of requested visit (format example 14:00)
*
Time
:
AM
PM
Preffered visiting spot
*
Garden
Frail care patio
Ward 5
Dining room courtyard
Lounge patio
Visit in room/ward (EXCEPTIONAL CIRCUMSTANCE ONLY)
Other:
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