Get the free Homemaker Referral Form - Health Services for Central East

CITY OF PETERBOROUGH HOMEMAKING SERVICES REFERRAL FORM SECTION 1 APPLICANT INFORMATION Name: Phone: Address: (Include directions if necessary) DOB: (mm//dd/by): Contact Person if not Applicant: REASON

How to fill out homemaker referral form

How to fill out a homemaker referral form:

1. Start by filling in your personal information, including your name, address, and contact information.
2. Next, provide information about the type of homemaker services you are seeking. Specify the specific tasks or assistance you require, such as meal preparation, light housekeeping, or personal care.
3. Indicate any preferred qualifications or certifications you would like the homemaker to have, such as first aid training or experience with elderly care.
4. If you have any specific scheduling preferences or requirements, make sure to note them on the form. This will help match you with a homemaker whose availability aligns with your needs.
5. If there are any additional details or specific instructions you would like to include, provide them in the designated section of the form.
6. Finally, review the form to ensure all the required fields are completed accurately. If necessary, double-check that you have provided all the necessary supporting documentation, such as medical records or insurance information.

Who needs a homemaker referral form:

1. Individuals who require assistance with daily household tasks but are unable to perform them independently may need a homemaker referral form.
2. Elderly individuals who may need support with meal preparation, housekeeping, medication management, or personal care could benefit from completing a homemaker referral form.
3. Families with young children or individuals with disabilities or medical conditions that prevent them from carrying out routine household chores may also require a homemaker referral form to access appropriate assistance.

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