Client Intake Form – Seniorly Yours LLC
Start Senior Care with One Simple Step. At Seniorly Yours LLC, we simplify the process of receiving home care in North Central Texas. Whether you’re planning care for a parent, spouse, or yourself, completing our official Client Intake Form helps us understand your needs and begin the right kind of support.
Families in North Central Texas trust us to make this step fast, clear, and secure.
What the Client Intake Form Includes
The form gathers essential information to create your customized care plan:
- Contact and emergency details
- Family or POA representative info
- Services requested (e.g., bathing, meals, shopping, grooming)
- Health conditions and mobility support
- Caregiver preferences or concerns
- Preferred schedule (days, times)
- Insurance, private pay, or VA status
It’s short, straightforward, and private. We only use this form to support your care.
Why Complete the Client Intake Form Now?
Completing the Client Intake Form – Seniorly Yours LLC allows us to:
- Assign a compatible caregiver faster
- Coordinate the right service days/times
- Avoid delays in your care plan
- Understand specific care needs up front
- Start your intake without phone back-and-forth
You’ll hear from our team within 1 business day guaranteed.
Submit the Client Intake Form
Click below to fill out the official Client Intake Form online. You may also print and email or fax it to our office.
Your information is kept confidential and reviewed only by our intake team.
Frequently Asked Questions
How do I submit the Client Intake Form?
You can complete it online or print and fax it to our office in Graham, TX. We confirm receipt and respond quickly.
What’s needed to complete the Client Intake Form?
You’ll need basic personal info, emergency contacts, health details, and service preferences to help us build your care plan.
Have Questions or Need Help?
We’re ready to walk you through the form or answer anything that’s unclear. Reach us directly at:
- Phone: (940) 550-3040
- Fax: (940) 550-3032
- Address: 523 Elm Street, Graham, TX 76450
We’re here to support you, every step of the way.