Initial Consult | Geriatric Planning

Where does your loved one live? Required

In their home alone.

In their home with spouse/family.

In my home or a family member's home.

In a senior care community; provide name in Additional Comments.

Other, explain in Additional Comments.

What is your loved one's health condition? Required

In good health but getting older.

Has been diagnosed with dementia.

Dementia symptoms are sometimes.

Dementia symptoms are frequent..

Dementia symptoms are very significant daily..

Other, explain in Additional Comments.

What care is your loved one receiving? Required

My loved one lives alone with no care.

I provide their care needs.

Additional family members help with care.

We hire caregivers.

Care is provided by their senior care community.

Other, explain in Additional Comments

What type of care support is needed? Required

We need help knowing what care is needed.

We need help finding care providers.

We need to know about care options.

Our family needs help working together.

I need caregiver support.

Other, explain in Additional Comments

Does your loved one have?

Long Term Care Insurance

Healthcare POA

Advance Directive

Will require Medicaid

In what city do you live? Required

How did you hear about Geriatric Planning? Required

Google search

Geriatric Planning website

Dementia Specialist website

An association referral list, please provide association name in Additional Comments

I'm a returning client

If referred by a client or a friend, please provide their name in Additional Comments

Other, explain in Additional Comments