Care Assessment Reflecting on the past few months, have you noticed that your loved one frequently:Fails to prepare and eat meals on a regular basis throughout the day?*YesNoDoesn’t keep the kitchen stocked with nutritious foods?*YesNoIs losing weight?*YesNoForgets to take prescribed medications as directed?*YesNoNeglects personal grooming and hygiene?*YesNoHas cuts or bruises that might be evidence of a fall?*YesNoHas difficulty navigating stairs or moving around the house?*YesNoShows signs of confusion or disorientation?*YesNoCannot safely operate a vehicle?*YesNoHas withdrawn from friends and other social activities?*YesNoNeglects household chores?*YesNoBefore we proceed, tell us a little about yourself.I’m interested in care for:*Family MemberFriendCity seeking care in:*Service(s) Interested in Learning More About: In-Home Care Services Geriatric Care Management Senior Living Locator Services Estate Liquidation ServicesContact InformationFirst Name*Last Name*Email* Phone*Preferred method of contact:*PhoneEmailCommentsThis field is for validation purposes and should be left unchanged.