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Sign Up for CareCall

CareCall is a free program from Lakes Regional Healthcare. Trained volunteers make a friendly phone call once a week to older adults and homebound residents of Dickinson County. Fill out this short form for yourself or someone you know, and a member of our team will call to talk about your eligibility for the program. Please note, this form is not for emergencies. If someone needs help right now, call 911.
1.Who is filling out this form?(Required.)
2.What is the name of the person who would receive calls (first and last name)?(Required.)
3.What is the phone number of the person who would receive calls?(Required.)
4.Does the person live in Dickinson County, Iowa?(Required.)
5.What is the best time of day for our team to call them?(Required.)
6.Does this person know about this sign-up and want to receive calls?(Required.)
7.If you're signing up someone else, what is your name, phone number, and relationship to them?
8.How did you hear about CareCall?
9.Please tell us anything else you'd like us to know. Please do NOT include medical information. We'll talk through details on the phone.
Thank you for your interest in CareCall. A member of the Lakes Regional Healthcare team will call you within 10 business days to talk about the program. If you have questions before then, call 712-336-8799.