Thank you for considering our Live-in Care services. To help us better understand your needs and provide the most appropriate care, we kindly ask you to complete the following questionnaire. This survey will gather essential information about the person requiring care, the current care arrangements, and logistical details to ensure we can offer a tailored and efficient service.
Section 1: Enquirer Details

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* 1. Full name:

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* 2. Email address

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* 3. Contact Number

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* 4. Do you have Health and Welfare Lasting Power of Attorney (LPOA) for the person receiving care?

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* 5. Do you have Property and Financial Affairs Lasting Power of Attorney (LPOA) for the person receiving care?

Section 2: Payment Information

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* 6. How will the care be funded

Section 3: Care Recipient Details

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* 7. Full Name

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* 8. Date of Birth

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* 9. Address where care will take place

Section 4: Current Care Information

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* 10. Is there any current professional care service in place?

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* 11. Please describe the current care arrangements

Section 5: Medical Information

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* 12. List any medical conditions and diagnose

Section 6: Logistical Information

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* 13. Expected start date for the Live-in Care

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* 14. Is the property suitable for Live-in Care?

Section 7: Additional Information

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* 15. Any additional information or special requirements you feel may be important to know

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