By completing and submitting this form, a staff member of Comfort Care will be in contact with you to speak with you about services offered by Comfort Care
Whom are you inquiring on behalf of?
City and State Services are needed
Type of Health Insurance
Please choose all types of health insurance that you currently have
Veteran Adminsitration (VA)
Long Term Care Insurance Policy
Types of services you would like to know about
Personal Care (Bathing, dressing, grooming, toileting assistance)
Household Chores (General household cleaning, laundry, shopping/errands)
Nursing Visits for Medication assistance
Private Duty Nursing
Helping assist a family member and getting paid for it
Send me a copy of my responses.
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