Winter Haven Use Form Below for Info & Pricing Or Call (863) 616-1888 Who Needs Care at Home?*Select OneMyselfSpouseParentGrandparentOther RelativeFriendOtherMale or Female?*Select OneMaleFemaleWhat is their current living situation?*Select OneLiving Alone at HomeLiving at Home with FamilyIn the HospitalIn the Hospital Discharging to HomeAssisted LivingIndependent Senior LivingNursing HomeIn Hospital Discharging to FacilityOtherEstimate How Much Care They Might Need*Select OneA few hours per weekMore than 20 hours per weekAround-the-Clock CareOtherWhat Type of Care is Needed? (Check all that apply)* Companionship Care (light housekeeping, meal preparation) Personal Care (bathing, hygiene, dressing, ambulation) Continuous 24/7 Care Alzheimer’s and Dementia Care Transitional Care Post Operation care & Home Recovery Skilled Nursing Care Transportation to Appointments Medication Reminders Respite Care Hospice Care Other Where Care is Needed?*Select OneLakelandWinter HavenPlant CityAuburndaleBartowHaines CityMulberryDavenportLake WalesOtherName of Person Submitting this Form* First Last Your Email Address- We will send you information via email.* Phone Number of Person Submitting this Form*QuestionsCAPTCHA