Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Join Home Care We are excited to deliver optimized and relevant health experiences to you! Your well-being is our priority, and this information will help us tailor our services to your specific needs. Your Name *Email *Date Of Birth *Phone Number *Emergency Contact Name *Emergency Contact Phone Number *NextYour Health Preferences Providing the following information can help us tailor membership services to your health needs. Select the type of care you needSelect careCompanion CarePersonal Assistance CareSkilled Nurse CareRespite Care (Short Term)Care CoordinationAssisted Living PlacementSelect how often you would like to receive this type of care per week:1 day2 days3 days4 days5 days6 days7 daysWould you like to join a primary care membership? *No, ThanksYesIn-person Home Care Assessment: Thank you for providing your information. We will use it to tailor our services to your specific needs. Let’s go ahead and schedule an in-person client assessment of your health concerns and environment. This will allow us to determine and tailor a custom home care plan suitable for you. Your Membership Plan The following membership plan has been selected based on the information provided. Layout Concierge Silver+ + $1,188 /year | $99 /month Your membership benefits include: Telehealth Services Concierge Home Visits Same / Next Day Appointments 24/7 Chat via Portal Select Membership Plan *Concierge Silver+ $99/monthSelect Membership Plan *Concierge Silver+ $1,188/yearAdd Services Concierge Platinum+ $597/yearAdd ServicesConcierge Platinum+ $49.75/monthSelect Billing period *Yearly (5% Off)Yearly (5% Off)MonthlyPayment Summary$ 0.00Stripe Credit Card *PreviousSubmit