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Let's Get Started!

Please fill out the following information.


I am a Arizona resident
Who needs care at home?
How much care is needed?
A few hours per week
More than 20 hours per week
40 or more hours per weel
Around the clock care
Live in care
Independent senior living
How will care be paid for?
Private funds
Long-Term Care Insurance
Veterans Administration (VA) Aid and Attendance Pension Benefit
Medicaid and State Programs
Medicare
Male or Female?
Male
Female
What is the current living situation?
Living at home alone
Living at home with family
In the hospital, needs a sitter
In the hospital discharging to home
Assisted living facility
Independent Senior Living
How much care is needed?
A few hours per week
More than 20 hours per week
40 or more hours per week
Around-the-clock care
Live in care
Independent senior living
How will care be paid for?
What type of care is needed?
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