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Book an At-home Consultation

In-home ConsultationEvery client's needs are unique so we will take time to work with you to develop a care plan that suits your needs and budget.
 
Simply complete the form below and we will call you to arrange a time for you to sit down within the home where the services will be provided, or if preferred over the phone, to discuss and assess such things as:-
 
  • Home safety
  • Services required
  • Regularity of the services
  • Our processes to stay connected with you and providing regular feedback
  • Service costs
 
NB: The in-home consultation carries no cost, nor obligations.
 
 

 

* Denotes required field

Your details

Title*:
First Name*:
Family Name*:
Street Address*
Suburb*:
State*:
Postcode*:
Email*:
Home phone:
Mobile phone:
Who are you requesting services on behalf of?
Self
Parent
Child
Spouse
Client

Client details (if you are looking into services for another)

First Name*:
Family Name*:
Street Address*
Suburb*:
State*:
Postcode*:

Questionnaire

How would you prefer that we contact you?*
Mobile phone
Home Phone
Email
Please select a day, or days, that are most convenient for an in-home consultation (NB: multiple selections are possible)*.
Monday
Tuesday
Wednesday
Thursday
Friday
Please select a time of the day would be convenient? (NB: multiple selections are possible).
9am - 11 am
11am- 2 pm
2pm -5pm
After hours*
Below we list some of the services available. Please tick the services that may be of interest:
Personal care
Respite Care
Check visits
Domestic Help
Dementia Care
Disability Care
Meal preparation
24-hour care
Nursing services
Child babysitting
Social outings/Shopping
Transport
Overnight care
Other
Has the client been diagnosed with dementia?
Yes
No
Have you successfully sought government assistance to help with the financial costs of care services?
Yes
No
Please describe any issues that you feel may be relevant (e.g. Cultural or gender preference of a carer)
Are you happy for Caring Choice to provide you with further information in the future?
Yes
No
 

Downloadable Resources

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Call Caring Choice on (08) 8431 0054
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Caring Choice is a proudly South Australian owned organisation..