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First Name
City
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Toronto
Ottawa
Greater Toronto Area
Hamilton
Niagara Region
Sudbury
Phone/Mobile
Email Address
Who needs care?
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Care on behalf of someone
Care for myself
Urgency:
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Need care within 24 hours
Need care within 48 hours
Need care within 1 week
Planning ahead
Service type:
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Personal care
Dementia/cognitive support
Respite
Homemaking
Meal preparation
Overnight care
Post-hospital support
Safety flags/Risks:
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Falls risk
Wandering
Recent hospital discharge
Unsafe transfers
Caregiver burnout
None of the above
Best Callback Time
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Morning
Afternoon
Evening
First available
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