Care Consultation By Email

 The reply will be via email; if you would like the assessment and brochure sent via Canada Post,

 please provide complete address information 

 
Contact Name
Address
City    Prov.     PC   
Daytime Phone     Cell     
E-mail    Please Call Me ASAP 

Please Check All Boxes That Apply a

 
Alzheimer's      Parkinson's   Heart Cond.  Breathing
Diabetic T1     Diabetic T2   Cancer Dementia  
Vision Loss     Blind  Hearing Loss   Deaf  
Walking AssistanceWheelchair Assistance   Cane Assistance
Incontinence Issues     Senior Has Fallen             Bathing Assist
Monitor Food ExpirationFeeding AssistMonitor diet and Eating 
Provide Companionship Read Aloud   Bathroom Cleanup    
Change Linens Light Vacuum Cleanup
Meal Prep      Light Housekeeping  Kitchen Cleanup
Attend events    Escort To Doctors Caregiver Needs CarCaregiver doesn't need car Laundry services?
Senior's Relation To You
Seniors City +Main Intersection
Senior's Age
Service required per week
Requested Schedule
Smoker
Pets
Laundry machines
Other Health Issues

      

(Please Check All That Apply) a

How did you hear about Guardian Angel Care?        

Hourly Rates Requested Yahoo      Google     Other Search Engine 
Overnight Care Rate Requested Print Ad (news, magazine) 
Live In Rate Requested
Please Call Me ASAP 

Please note that our minimum shift is 3 hours per visit.
 

 

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