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Assess Your Needs

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General

General Information

Answer the following questions to receive a customized care recommendation tailored to your family's specific needs. You can save your results and share them with other family members. Please answer questions to the best of your ability.

All questions are required unless otherwise noted.

Privacy Statement
Your privacy is important to us - we do not share your information with care providers without your permission.

What is the first name of the senior in need of care?(OPTIONAL)

We are collecting this information to tailor the questionnaire and results. It is strictly confidential.

What is the senior’s gender?

Male

Female

What is your relationship to the senior in need of care?

Spouse

Daughter or son

Granddaughter or grandson

Sibling or family

Friend

Self

Other

By using the Needs Assessment, you agree to our Terms of Use and Privacy Policy.