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Serving the Pittsburgh & the Surrounding Cities of Mt Lebanon, Harmarville, New Kensington, McKeesport, North Hills, Greensburg, South Hills, Monroeville, & Carnegie.
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Get Started
Get Started with Extended Family Care Services in Pittsburgh. Fill out the form below.
Use This Form to Receive Immediate Info
When you fill out this form you can expect immediate information, pricing and communication with a caring staff member from our office.
Who Needs Care at Home?
*
Select One
Myself
Child Under 18
Spouse
Parent
Grandparent
Other Relative
Friend
Other
How Old is the Person Who Needs Care?
*
Select One
Child 0-18
Adult 18-44
45-54
55-64
65-74
75-84
85 or older
Male or Female?
*
Select One
Male
Female
What is their current living situation?
*
Select One
Living Alone at Home
Living at Home with Family
In the Hospital Needs a Sitter
In the Hospital Discharging to Home
Assisted Living
Independent Senior Living
Nursing Home
Estimate How Much Care They Might Need
*
Select One
A few hours per week
More than 20 hours per week
40 or more hours per week
Around-the-Clock Care
Live-In Care
What Type of Care is Needed? (Check all that apply)
*
Light Meal Preparation
Light Laundry
Light Housekeeping
Companionship
Transportation to Appointments
Grocery Shopping
Errands
Bathing
Toileting
Medication Reminders
Respite Care
Hospice
How will care be paid for?
*
Private Funds
Long-Term Care Insurance
Medicaid
Other - (VA Aid and Attendance, Reverse Mortgage, etc)
Zip Code Where Care is Needed
*
Name of Person Submitting this Form
*
First
Last
Your Email Address- We will send you information via email.
*
Phone Number of Person Submitting this Form
*
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