Senior/Family Pilot Sign-Up

Register for Personalized Senior Care

Fill out your information to receive the right care, support, and attention you deserve.

Are you signing up for yourself or a family member?

Myself Family Member

a. If family member:

First Name / Last Name

Phone

b. Are you the power of attorney (POA) of the senior?

Yes No

Senior First Name

Last Name

Preferred Contact Method (Phone / Email)

Phone Email

Phone

City / Town

Tell Us About Your Care Needs

Please share a few details about your medications and daily assistance needs so we can personalize your care.

Have you had an RN care assessment in the last 12 months?

Yes No Not Sure

If not, would you like an care assessment?

Yes No

Please check all that apply (Does the Senior use any of the following Medications?)

Oral Topical Injectable IV Inhalers Eye Drops Insulin Oxygen Wound Care Wheelchair Walker Mechanical Lift Ventilator

Please check all that apply (Does the Senior need assistance with any of the following?)

Medication Set-up Medication Assistance Medication Administration Mobility Dressing Toileting Meal Prep Eating Transportation Blood Draw Companionship Light Housekeeping Medical conditions Recent change in medical status Bathing Special Diet

Tell Us About Your Care Needs

Please share a few details about your medications and daily assistance needs so we can personalize your care.

Preferred Practitioner Type

Preferred Days/Times for Visits

Additional Notes – Any preferences, care background, or special requests.

Caredara. It's a lot. We Care.™ On-demand home care from trusted PSWs, RPNs, and RNs — with no contracts, no minimums, and clear hourly rates.

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[email protected]
5063 North Service Rd., Suite 100 Burlington, ON L7L 5H6
1-888-822-7398
24/7 Support

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Caredara™. It's a lot. We care.