Great Care of Indianapolis
Home Care Services Indianapolis IN
Home Care in Indianapolis
Call us for Great Care (317) 595-9933
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Home Care Services
Home Care Services in Indianapolis, IN
Home Care Services in Avon, IN
Home Care Services in Broadripple, IN
Home Care Services in Brownsburg, IN
Home Care Services in Carmel, IN
Home Care Services in Fishers, IN
Home Care Services in Greenfield, IN
Home Care Services in Greenwood, IN
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Hourly Senior Care in Avon
Home Care Services in Zionsville, IN
24 Hour Elderly Home Care Services
Morning & Evening Caregiver in Broadripple
Overnight Home Care (12 Hour Care)
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Use This Form to Receive Immediate Info or Call (317) 595-9933
Who Needs Care at Home?
*
Select One
Myself
Spouse
Parent
Grandparent
Other Relative
Friend
Other
How Old is the Person Who Needs Care?
*
Select One
45-54
55-64
65-74
75-84
85 or older
Male or Female?
*
Select One
Male
Female
What is their current living situation?
*
Select One
Living Alone at Home
Living at Home with Family
In the Hospital Needs a Sitter
In the Hospital Discharging to Home
Assisted Living
Independent Senior Living
Nursing Home
Estimate How Much Care They Might Need
*
Select One
A few hours per week
More than 20 hours per week
40 or more hours per week
Around-the-Clock Care
Live-In Care
What Type of Care is Needed? (Check all that apply)
*
Light Meal Preparation
Light Laundry
Light Housekeeping
Companionship
Transportation to Appointments
Grocery Shopping
Errands
Bathing
Toileting
Medication Reminders
Respite Care
Hospice
How will care be paid for?
*
Private Funds
Long-Term Care Insurance
Medicaid
Other - (VA Aid and Attendance, Reverse Mortgage, etc)
Many Senior In-Home Care services and products are not covered by insurance, Medicare, Medicaid or public assistance. Most individuals and families often need to pay "out-of-pocket" for some or all services requested. Are there other sources of financing available to you, such as Social Security benefits, VA benefits, or Private Funds?
*
Yes
No
I don't know
Zip Code Where Care is Needed
*
Name of Person Submitting this Form
*
First
Last
Your Email Address- We will send you information via email.
*
Phone Number of Person Submitting this Form
*
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