+1 (647) 969-2982

Request a Free Palliative Care Consultation

Complete the form below and a member of our care team will contact you shortly to discuss your needs, answer your questions, and help you explore the most appropriate care options.

Tell Us How to Reach You

Please provide your contact information and a member of our care team will reach out to discuss your care needs.
Name

Tell Us About Your Care Needs

Help Us Understand the Support You're Looking For
What is happening right now that makes palliative supportive home care feel important for your family? (Tick all that apply)
What support would help the person feel more comfortable, safe, and respected at home? (Tick all that apply)
What would a successful palliative support plan protect or achieve for the person and family in the coming days, weeks, or months? (Tick all that Apply)
Consent
By submitting this form, you consent to NtongoCARE collecting and using your personal information solely to provide dementia care consultation and services. We comply with Ontario’s Personal Health Information Protection Act (PHIPA). Your information will not be shared with third parties without your consent, except as required by law. You may withdraw consent at any time.

Need Immediate Assistance?

Our care team is available to discuss your situation and answer questions about dementia care services.