Tell Us How We Can Help

 

At Plum Living we know that Home Health Care is much more than having trusted, professional, personal care. It is about being able to be Yourself with people You choose to play a part in your life. We are dedicated to the lifestyle values of respect, independence, support, happiness and trust.

The answers to the following questsions will help us in undertanding the needs of the person considering services and will assist us in suggesting a level of services that is appropriate. Please provide as much information as possible. Questions marked with a * are required. It will take approximately 5 - 10 minutes to answer these questions. All information provided is strictly confidential.

Once you have completed this information, someone from Plum Living will contact you to discuss the needs identified.
 
 
Identification
* The person considering Services is:
 
Me
 
Partner/Spouse
 
Parent
 
Sister/Brother
 
Grandparent
 
Aunt/Uncle
 
Friend
 
Other
 
 
 
* Age of person requiring/considering services
   
 
 
* Self-Identified Gender
Female Male Trans-Male Trans-Female Other
 
 

* How soon are services needed?
Immediately 2 - 3 weeks 4 - 6 weeks Within 1 year Not sure Other  
 

* How long will services be required? (Select all that apply)
 
One-time
 
Short-term
 
Ongoing Weekly
 
Ongoing Bi-Weekly
 
Ongoing Monthly
 
24 Hour support
 
Not certain
 
Other helpful information:
 

 

The information you provide is confidential and protected.  If you have any concerns, please view our Privacy Policy.