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Await email from Caring for Dementia

– Within 1 business day you will receive an email with a link to the virtual meeting room via Google Meet (This will be your 10-15 minute video conference) -Please proceed below to sign the privacy policy and terms and conditions. This is a required step to complete the care planning booking process. -We aim to complete video conferences 2-3 business days following the submission of the form. – Please note you must provide payment 24 hours prior to video conference. – If we do not receive payment 24 hours in advance we will alert you to let you know we have cancelled your appointment. – We do our best to accommodate scheduling preferences, in the case we can not an alternative appointment time will be sent via email. – You may choose to accept this time or reply to the email with dates better suited for you.

Our Care Planning service requires a 10-15 minute video conference (you do not need to have your camera on) but must have a working microphone so we are able to ask more detailed and in depth questions about your loved one.

Within 24 hours after submitting this form, you will receive a link to the e-mail provided, enabling access to our virtual conference room via “Google Meet”. Google Meet must be installed to access the Care Planning service.

Caring for Dementia will aim to have care plans completed four business days after the submission of the form. We aim to complete video conferences 2-3 business days after form submission.

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You will Provide the emergency contact information (Phone number/E-mail) to the facility/Staff directly.

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Cognition Level
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Mobility(required)
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Sit to stand/Stand to sit transfers
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Assistive Devices(required)
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Does the client wear eye glasses?
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Does the client wear hearing aids?
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Is the client incontinent?
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Pain Levels (Daily Average scale of 10)(required)
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How often do the behaviours occur?
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Preferred Day (Choose all that apply)
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Preferred Appointment Time (Atlantic Standard Time GMT -04:00)(required)
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Please read Below before submitting form

(1) To complete the care planning booking process, you must complete and submit this form, sign the privacy policy/terms and conditions form, and process your payment.

(2) Within 24 hours of submission you will RECEIVE an e-mail with the virtual meeting link and your appointment time. 

(3) Please note that we can’t guaranteed preferred times, but will attempt to accomodate all scheduling preferences.

(4) By pressing submit you agree to allow Caring for dementia to correspond with you through the e-mail provided.

(5) Press Submit below And pROCEED TO THE pRIVACY pOLICY AND tERMS AND cONDITIONS.

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Electronic Form:

We use a third-party electronic signature program “JotForm” for your convenience.


         Process your payment

Please Read the following information carefully before providing payment for your Care Plan.

Privacy Policy/Terms & Conditions

Before you process your payment, please make sure you have filled out the client form on our website and signed the privacy policy and terms & conditions. Kindly note, the appointment cannot commence, even if paid for, until we receive the signed privacy policy and terms and conditions. Your prompt submission of these documents is essential for the initiation of our services.

Video Conference

  • To ensure we are providing a care plan with the most accurate information about your loved one, we kindly request a brief video conference approximately 10-15 minutes.
  • Within one business day of submitting the above form, you will receive a link to the e-mail provided, enabling access to our virtual conference room via “Google Meet”. Google Meet must be installed to access the Care Planning service.

Payment

All payments must be received 24 hours before scheduled video conference.

You may provide payment by using:

  • Credit Card
  • PayPal
  • E-transfer (See instructions to send e-transfer)

Detailed information on payments and revisions can be found in the signed agreement under terms and conditions.

Care Plan details

This is a personalized and custom care plan, designed by a behaviour support specialist with extensive training in advanced care planning, the care plan is priced at CA $50.00.

What is in a care plan?

Our care plans offer the following focuses:
Personal Hygiene
Dressing, toileting, bathing, grooming, oral care
Mobility
Transfers, walking, assistive devices, barriers to mobility
Communication
Hearing, vision, speech, written, cues required
Nutrition and Hydration
Likes, dislikes, allergies, modifications and cues required
Behaviour Support
Triggers, behaviours, interventions, communication strategies, risks to self and others
Typical Day Routine
Typical Night Routine
Activities and Hobbies
Past activities, present activities, likes, dislikes, cues required, barriers to recreation
Educational enhancements
These are generalized strategies and techniques that work well with the general population of dementia. Please read the terms and conditions for more information on educational enhancements.

Credit Card

We use Stripe to process our credit card payments.


PayPal

Dementia Care Plan

This is a personalized and tailored care plan to suit the needs of the individual with dementia.

CA$50.00



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