caregiverform | Senior Care Connect

What type of help/assistance are you able/trained to provide to clients? *

Bathing Assistance

Dressing

Toileting

Cleaning/Housekeeping

Grooming (i.e Brush/Wash Hair, Brush Teeth, etc)

Companionship (Social Engagement, Play Games, Observer/Sitter, Conversation, Walks, etc)

Assist with Mobility

Transfers

Accompany to Medical Appointments

Driving (able to drive client to appointments, groceries, etc)

Meal Preparation

Medication Reminders

Other:

How many years of experience do you have providing care to elderly/seniors? *

How much do you charge per hour? (i.e $18/hr, $21/hr, etc) *

Families often want to know about a caregiver's personality to help match the right person with their loved one. Please share some of your interests or hobbies? (Example: Travelling, Reading, Playing soccer, spending time with family, going to the movies, etc) *

What made you decide on a career in caregiving/Why did you want to become a caregiver? *

Other Comments

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