Visitor Request Form

Welcome to Lakeview. We are pleased to have you visit your loved one during their stay with us. All family members, chosen family members, and significant others must complete this form and submit it for approval before family visitation days, held every Sunday from 1:00 to 4:00 p.m. After receiving the form, a Lakeview team member will review it and contact you with further information.

Family involvement is a crucial part of the recovery and healing process. Visiting your loved one at Lakeview helps reinforce the importance of recovering as a family, providing support and encouragement in a tranquil setting. Each week, we welcome families to spend quality time together, fostering a supportive environment essential for recovery.

We ask that you respect our home, our community, and others who are joining us.

Visiting Hours: Sunday 1:30 pm - 4:00 pm

Please complete the following form if you wish to visit.

Resident Name

First Name

Last Name

Visitor Name

First Name

Last Name

Relationship to Resident

Phone

Address

Address 1

Address 2

City

ZIP / Postal Code

State / Province

Country

Confidentiality Agreement

I understand that the privacy of all residents at Lakeview is of utmost importance. Therefore, I agree to maintain the confidentiality of all residents, their identities, and any information disclosed during my visits to Lakeview. I will not disclose the identity of any resident, nor will I share any details or information that I may observe or hear while on the Lakeview property.
It is essential to respect the privacy of all residents by only sharing information about my own experience and not discussing or revealing the identity, personal details, or experiences of any fellow resident. This includes not discussing any confidential treatment details, personal stories, or interactions that occur within the facility.
I acknowledge that the Lakeview staff may be required to breach confidentiality in specific situations as mandated by federal and provincial laws, such as instances involving imminent harm, abuse, or criminal activities. I understand and accept that these legal obligations may override confidentiality agreements.
I agree to uphold the confidentiality terms outlined in this agreement and understand that any breach of this agreement may result in immediate termination of my visiting privileges and any legal consequences that may follow. I confirm that I will respect the confidentiality policies of Lakeview and support the well-being and privacy of all residents during my time on the premises.
By checking this box, you acknowledge and agree to uphold the terms of this confidentiality agreement, serving as your digital signature.

Date

Message