Intake Form
Elder Care Guidance LLC
Now Serving Illinois Families
Welcome. I am glad you are here.
Taking this step to seek support shows your deep commitment to your family. Before we speak, I would love to know a little about you and your loved one.
There are no wrong answers. Sharing the truth about where you are right now helps me to give you the best options for your family.
About Your Loved One
Tell me about the person at the heart of all this. You know them best. Share whatever feels important.
Their Care Needs
Please check anything that feels relevant. This helps me understand where your loved one is right now. There is no judgment here, only care.
What Brings You Here Today?
In your own words, what is your biggest concern or challenge right now?
Please share as much or as little as you feel comfortable sharing.
Agreements & Acknowledgements
By checking the box below, you confirm that you have read and agree to the Terms of Use for Elder Care Guidance LLC. This includes the scope of services offered, limitations of the advisory relationship, and expectations for our work together.
Your privacy matters deeply to me. By checking the box below, you confirm that you have read and agree to the Privacy Policy of Elder Care Guidance LLC, including how your personal information is collected, used, and protected.
Please note that Elder Care Guidance LLC provides guidance, advocacy, and educational support. I do not provide medical, legal, or financial advice. The information shared in this intake form will be kept strictly confidential and used only to prepare for our work together.
Thank you so much for taking the time to share your story with me. I look forward to connecting with you and walking alongside you on this journey.
- Sabrina, Elder Care Guidance LLC
