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Does your loved one require in-home support 24 hours a day?

Yes
No

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Is your loved one experiencing any of the following?
(Check all that apply or if none, click next)

Trouble Hearing/Hearing Loss

Low Vision/Difficulty Seeing

Difficulty Walking

Difficulty Eating

Depression

Falling

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Has your loved one stayed in any of the following in the last 6 months?
(Check all that apply or if none, click next)

Hospital

Rehab/Skilled Nursing Facility

Assisted Living Facility

In-Patient Stay

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Are they still under a doctor's prescribed regime/care plan?

Yes
No

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Does your loved one need someone to help them with any of the following?
(Check all that apply or if none, click next)

Getting Dressed

Bathing

Using the Bathroom

Preparing Meals

Taking Medications

Getting to the Doctor's Office

Next Back

Is your loved one having difficulty remembering things such as paying their bills each month?

Yes
No

Back

Has your loved one ever been diagnosed with dementia or Alzheimer's?

Yes
No

Back

Has your loved one ever wandered or driven away from a known location and felt disoriented or lost?

Yes
No

Back

Do you have additional information to share? (Optional): Get Results Back

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Comfort Careers

What type of care do you need?

I am taking this Care Questionnaire for:

Are you experiencing any of the following?
(Check all that apply or if none, click next)

Have you stayed in any of the following in the last 6 months?
(Check all that apply or if none, click next)

Are you still under a doctor's prescribed regime/care plan?

Do you need someone to help you with any of the following?
(Check all that apply or if none, click next)

Do you have difficulty remembering things such as paying your bills each month?

Have you ever been diagnosed with dementia or Alzheimer's?

Have you ever wandered or driven away from a known location and felt disoriented or lost?

Does your loved one require in-home support 24 hours a day?

Is your loved one experiencing any of the following?
(Check all that apply or if none, click next)

Has your loved one stayed in any of the following in the last 6 months?
(Check all that apply or if none, click next)

Are they still under a doctor's prescribed regime/care plan?

Does your loved one need someone to help them with any of the following?
(Check all that apply or if none, click next)

Is your loved one having difficulty remembering things such as paying their bills each month?

Has your loved one ever been diagnosed with dementia or Alzheimer's?

Has your loved one ever wandered or driven away from a known location and felt disoriented or lost?

Get In Touch

Speak with a senior resource counselor to discuss your results or request a full assessment.†

Find A Community

Save Your Results

Contact Us

Search the Site

Comfort Careers

What type of care do you need?

I am taking this Care Questionnaire for:

Are you experiencing any of the following?(Check all that apply or if none, click next)

Have you stayed in any of the following in the last 6 months?(Check all that apply or if none, click next)

Are you still under a doctor's prescribed regime/care plan?

Do you need someone to help you with any of the following?(Check all that apply or if none, click next)

Do you have difficulty remembering things such as paying your bills each month?

Have you ever been diagnosed with dementia or Alzheimer's?

Have you ever wandered or driven away from a known location and felt disoriented or lost?

Does your loved one require in-home support 24 hours a day?

Is your loved one experiencing any of the following?(Check all that apply or if none, click next)

Has your loved one stayed in any of the following in the last 6 months?(Check all that apply or if none, click next)

Are they still under a doctor's prescribed regime/care plan?

Does your loved one need someone to help them with any of the following?(Check all that apply or if none, click next)

Is your loved one having difficulty remembering things such as paying their bills each month?

Has your loved one ever been diagnosed with dementia or Alzheimer's?

Has your loved one ever wandered or driven away from a known location and felt disoriented or lost?

Get In Touch

Speak with a senior resource counselor to discuss your results or request a full assessment.†

Find A Community

Save Your Results

Contact us to discuss your results or request a full assessment†

Thank You!

Are you experiencing any of the following?
(Check all that apply or if none, click next)

Have you stayed in any of the following in the last 6 months?
(Check all that apply or if none, click next)

Do you need someone to help you with any of the following?
(Check all that apply or if none, click next)

Is your loved one experiencing any of the following?
(Check all that apply or if none, click next)

Has your loved one stayed in any of the following in the last 6 months?
(Check all that apply or if none, click next)

Does your loved one need someone to help them with any of the following?
(Check all that apply or if none, click next)