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Comfort Keepers Los Angeles, CA

5478 Wilshire Blvd # 218
Los Angeles, California 90036
(323) 601-0365

Home Care Survey

Name: Comfort Keepers Home Care
Address: 5478 Wilshire Blvd # 218, Los Angeles, California, 90036
Telephone: (323) 601-0365

Understanding your loved one’s needs is the first step toward finding suitable support. Take the Comfort Keepers survey to explore home care options in Los Angeles, CA. Answer questions about daily activities, personal preferences, and support needs to help identify the type of care that may be appropriate. Start the survey to better understand your loved one’s care needs.

Call us today at (323) 601-0365 to learn how Comfort Keepers can help your loved one live safely and comfortably at home.

About Your Loved One

Choose the following statements that apply to your loved one:

Does your loved one wear dirty clothing or the same outfit day after day?

Is it apparent your loved one is not showering or bathing?

Is your loved one losing weight?

Are there signs of confusion such as not knowing the date, where he/she is, or the season of the year?

Do the refrigerator or cupboards contain outdated food; or lack nutritious food?

Is the home cluttered or have mail, newspapers, bills accumulated?

Are you finding expired medications or medications that are not being taken?

ZIP Code where care is needed

About Yourself

Your first name

Your last name

Your email address

Your telephone number

Is this a cell phone number?

Anything else you would like to tell us?

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