For More Information or a FREE Consultation
Contact Us Below or CALL 619-286-9052
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Global Village Home Care
About Us
Home Care Services
Personal Care Services
Companionship Services
Homemaking Services
Respite Care
Needs Assessment
Contact Us
For More Information or a FREE Consultation
Contact Us Below or CALL
619-286-9052
Name
Phone Number
Email Address
How Can I Help You?
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Doesn’t keep the kitchen stocked with nutritious foods
Yes
No
Has trouble preparing and eating meals on a regular basis throughout the day
Yes
No
Experiencing weight loss
Yes
No
Forgets to take prescribed medications as directed
Yes
No
Neglects personal grooming and hygiene
Yes
No
Skips showers or baths
Yes
No
Wears the same clothes repeatedly without washing
Yes
No
Has cuts or bruises that might be evidence of a fall
Yes
No
Has difficulty navigating stairs or moving around the house
Yes
No
Has challenges getting in and out of bed
Yes
No
Has challenges getting in and out of the shower
Yes
No
Experiences trouble communicating with others
Yes
No
Shows signs of confusion or disorientation
Yes
No
Has trouble getting appointments, the store, etc
Yes
No
Lacks a viable means of transportation
Yes
No
Has withdrawn from friends and other social activities
Yes
No
Has a lack of interest in hobbies and other activities
Yes
No
Has trouble completing light household chores
Yes
No
Allows mail, newspapers and other clutter to accumulate
Yes
No
Has trouble remembering to pay bills
Yes
No
First Name
Last Name
Phone Number
Email Address
I need care for:
Family Member
Friend
Myself
Other
Need care in zip code:
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