Schedule an In-Person Visit

Thank You!
Your request to bring a second guest with you has been received!
As soon your "in-person" visit request is confirmed, you will receive an email with the scheduled date & time.

Are you interested in bringing a third guest with you?
If yes, then please continue by filling out the form below.

Before submitting your request form for a third guest...

Please be advised that ALL VISITORS MUST READ our information regarding "infection prevention" and our "visitation guidelines" contained in the two files below prior to ALL IN-PERSON VISITS. You will be asked to acknowledge that you and your guests understand and agree to this while completing our "in-person" visitation online form.

in-person_visit_packet_-_mask_-_handwashing_docs.pdf
File Size:	1549 kb
File Type:	pdf

Download File

in-person_visitation_guidelines_and_general_information__form_october_2021_new.pdf
File Size:	212 kb
File Type:	pdf

Download File

Resident You Would like To Visit In-Person

* Indicates required field

Resident Full Name (First & Last) *

Guest #3

Guest #3 First Name *

Guest #3 Last Name *

Guest #3 Email *

Guest #3 Cell Phone *

Guest #3 Address 1 *

Guest #3 Address 2 *

Guest #3 City *

Guest #3 State *

Guest #3 Zip *

Please answer the following series of questions designed for Guest #3
Recent Travel and Contact with someone who has COVID

Has Guest #3 been in contact with anyone with COVID-19 within the past 14 days? *

Yes No

Has Guest #3 traveled internationally within the past 14 days? *

Yes No

If you answered YES to either or both of the above questions, STOP!
I am sorry, but Guest #3 will need to meet the 14 Day Quarantine requirement prior to scheduling an "in-person" visit.
If you answered NO to both questions...
please continue.

COVID Testing prior to your visit if Guest #3 is not vaccinated
We highly encourage all visitors to bring a PCR test result prior to visit (result within 72 hours of the scheduled visit)

Will you be bringing the "results" from a PCR test which will have been administered within 72 hours of your scheduled visit date/time? *

Yes No Does not apply, Guest #3 is Vaccinated

Infection Prevention and Visitation Guidelines

Please acknowledge that your third guest will have read the two documents from the top of this page regarding infection prevention and visitation guidelines prior to their visit. *

Yes, I downloaded/printed them and they will have read them prior to our visit

Submit In-Person Visit Request for Guest #3

Chapin Home for the Aging
165–01 Chapin Parkway
Jamaica‚ NY 11432
(718) 739–2523 Ext. 2814
JAponte@chapinhome.org