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Comfort Keepers Sterling, VA

45640 Willow Pond Plaza Suite 100
Sterling, Virginia 20164
(703) 239-3858

Comfort Keepers Home Care Survey – Sterling, VA

Name: Comfort Keepers Home Care
Address: 45640 Willow Pond Plaza Suite 100, Sterling, Virginia, 20164
Telephone: (703) 239-3858

At Comfort Keepers, our top priority is providing personalized care that meets our clients’ needs. To help us do this, we invite you to complete this simple survey. Your responses will give our team valuable insights, allowing us to plan and tailor the care and support we provide specifically for you or your loved one.

This survey is crucial in understanding individual preferences, health requirements, and lifestyle choices. By sharing your honest feedback, you help us create a care plan that promotes comfort, independence, and well-being.

Thank you for taking the time to help us serve you better. If you have any questions or need assistance with the survey, please don’t hesitate to contact our Sterling, VA office.

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Do the refrigerator or cupboards contain outdated food; or lack nutritious food?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