In Home Care Assessment Tool | Sunlight Support

We all have family members and friends that at times seem to have difficulty with everyday activities. Activities that we take for granted. Their difficulties may be a direct result of the aging process or from a traumatic head or other physical injury.

Whether a close friend or family member is involved, please take a few minutes and complete this brief Care Assessment. By asking a few questions about your loved one we will better understand their situation. We will ask a few questions about you to help us identify what help you need with your loved one.

When you have completed the Care Assessment we will assist you in identifying where your loved and yourself may best benefit from our services.

Please take a couple minutes to answer questions about you so that we better understand your present situation:

Name*

First Last

Phone*

Email

Preferred Method of Communication*

Phone
Email

What is the best time of day to reach you?*

Morning
Afternoon
Evening

City*

State*

Who is this care for?*

Current living situation of care recipient:*

Estimated level of care:*

Minimal care (less than 10 hrs/week)
Basic care (less than 20 hrs/week)
Daily care (20+ hrs/week)
Full time care (40+ hrs/week)

General services needed (check all that apply):*

How do you plan on financing? (select all that apply)*

Private funds
Long term care insurance
Medicaid/public assistance
Other (social security, VA benefits, etc)