Step 3

Blueprint - Step 3

Step 3

HomeCare West Checklist

Let us help you find the perfect home care solution!

Fill out the checklist below as best as you can and we will get back to you soon.

Your Name (required)

Your Email (required)

Personal Care

Bathing Bathroom assistance Medication assistance Oral care Dressing Meal Assistance Unsure 

Mobility Assistance

Lifting  Transferring Walking Unsure 

Companionship

Escort to medical appointment  Social companion Letter/card writing Administrative assistance Emailing and computer coaching Unsure 

Domestic Support

Meal prep Shopping Housekeeping Laundry Bed making Errands Ordering equipment Liaison/advocate Booking appointments Unsure 

Your Message

Don’t forget to print out this form!

Once you have submitted this form, you will be emailed a copy. Please print it out as this is the Blueprint we will refer to in our correspondence. Thank you for your interest in HomeCare West.

Our Brochure

Know someone who needs Home Care or may be interested in our services? Download our brochure here and pass it on.