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I Am Cared For

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Phone: 803-961-4111

Fax: 803-961-3111

Email: info@iamcaredfor.org

Address:

68 Pine House Rd

Trenton, SC 29829

Opening hours- Mon - Fri: 8am - 8pm

PATIENT INFORMATION

First name

Last name

Code

Phone

Email

Zipcode

Have you and/or your loved one fallen in the past month?

Yes

No

Have you and/or your loved one been to the ER in the past three months?

Yes

No

Is it a taxing effort to complete the following:

Bath/ Hygiene

Meal Prep/ Feeding self

Companionship

Housekeeping

If you answered YES to one of these questions our team is on standby to assist you and/or your loved one. A member of our team will be contacting you shortly.

I AM CARED FOR!

Thank you for your submission!

Phone: 803-961-4111

Fax: 803-961-3111

Email: info@iamcaredfor.org

Address:

68 Pine House Rd

Trenton, SC 29829

Opening hours- Mon - Fri: 8am - 8pm

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