Caregiver Intake Form - COOK COUNTY ONLY
I'm currently surveying those who may wish to obtain a Home Health Care Aide.
Also, I'm currently surveying those who may have a relative, friend, or neighbor who would like for them to be their paid Home Care Aid.

If either of these fits you, please complete the form below and we will have someone contact you.

These are some of the duties of a Home Health Care Aide.

Assistance with personal hygiene and ADL (Activities of Daily Living)
Meal preparation
Meal Planning and Nutritional Guidance
Medication reminders
Mobility assistance
Personal care and attention
Personal laundry services and clothing care
Post-surgery care and pre-surgery preparation
Preventing falls and health complications
Transportation services (to medical and dental appointments)

Thank you so much for your time.

Sonja Cassandra Perdue
I need a caregiver.
Clear selection
I wish to recommend someone who wants me to be their caregiver.
Clear selection
Name *
Email *
State *
Age *
Gender *
Telephone Number *
What is a good time to call you? *
My organization is involved in many other services, events and activities. May we add you to our mailing list? Sonja Cassandra Perdue, Founder *
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