Affordable Caregivers Inc

Client Application

Virtual Nurses assigned to each client and their family.

Person Who Will Be Receiving Care

(we do not contact them)

Primary Point of Contact:

(This will be the person we call now to coordinate care)

Secondary Point of Contact:

Have you already spoken to someone from Affordable Caregivers?

IF YES,

Schedule

If in the facility/Hospital:


For Hourly: ( 4 hrs minimum per visit)

Total Hours

Start Time

End Time

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday


For Live In:


Others:


Please Note:

Most hourly caregivers drive, live in caregivers generally do not drive although they typically have someone drop them off and pick them up and can usually handle the grocery shopping for the client. Live in caregivers who drive are rare and in demand, they usually request an extra $20 per day because they are a live in driver.


Also, most caregivers are requesting $1/mile for mileage if they are driving their own vehicle.


Client's Information

Physician :


Specialist (e.g. Neurologist)

General Practitioner

Insurance

If yes:

(LTC is different than medical insurance, unfortunately, medical insurance doesn’t usually cover caregivers, this is why we try to be affordable, and for most client this is out of pocket expense. Long Term Care insurance is typically sold by a Life insurance agent).

Clients Pre-Requisites for Caregivers:

(Examples: Drving Caregiver, Caregiver experienced with Uber, Caregiver required to fill out paperwork, Caregiver who speaks Spanish etc.)

Client's Billing

We only accept:

Debit Card, Check/Electronic Check, Electromic Fund Transfer(Zelle)