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Active Care Team Registration
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Name
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Phone Number
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OPTIONAL QUESTIONS
It's not necessary to complete the following questions (you can submit the form now). If you do complete some or all of the optional questions, we'll use the information to coordinate care activities.
What types of support are you willing to provide? (Select all that apply.)
Giving rides
Preparing meals
Keeping someone company
Domestic chores (cleaning, yard care, etc)
Information chores (managing accounts, appointments, paperwork, etc)
Sign me up for anything
Other:
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