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Home
About Us
Services
Chronic & Specialized Care
Adult & Child Disability Care
Cancer Care
Diabetes & Dialysis Care
Memory Care (Alzheimer’s & Dementia)
Parkinsons Care
Stroke Recovery Care
Post-Surgical & Mobility Recovery
Orthopedic & Surgical Recovery
Hospice & Palliative Care
Essential Home Care
Child Care Services
Respite Care
24/7 Home Care
Companion & Travel Assistance
Areas We Service
Pricing
Careers
Blog
Contact Us
561-678-0111
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Guaranteed Compatibility - Caregivers
Step
1
of
2
50%
At FLORIDIA CONCIERGE HOME CARE, we guarantee our clients will be matched with a caregiver that not only precisely followstheir unique plan of care, but they are also compatible on a social levelso they have the best care experience possible. In addition, we want to provide a great match for our caregivers as well. By knowing your likes and dislikes, we will work to match you with a client where you can be most productive and effective.
Name
Date
MM slash DD slash YYYY
Watching TV / Movies
LIKE
NEUTRAL
DISLIKE
Cleaning
LIKE
NEUTRAL
DISLIKE
Interacting with pets
LIKE
NEUTRAL
DISLIKE
Playing card games
LIKE
NEUTRAL
DISLIKE
Playing board games
LIKE
NEUTRAL
DISLIKE
Cooking
LIKE
NEUTRAL
DISLIKE
Baking
LIKE
NEUTRAL
DISLIKE
Doing crafts
LIKE
NEUTRAL
DISLIKE
Light outdoor activities (bird watching,sitting outside)
LIKE
NEUTRAL
DISLIKE
Moderate outdoor activities (gardening, going for a walk)
LIKE
NEUTRAL
DISLIKE
Reading
LIKE
NEUTRAL
DISLIKE
Listening to music
LIKE
NEUTRAL
DISLIKE
Watching or talking aboutsports
LIKE
NEUTRAL
DISLIKE
Singing
LIKE
NEUTRAL
DISLIKE
Smoking or being in a smoking environment
LIKE
NEUTRAL
DISLIKE
FLORIDA CONCIERGE HOME CARE will make every attempt to place caregivers on assignmentsthat minimize their “dislikes”. However, based on the client’s needs and plan of care, certain activities may be required. If there is a compelling reason why you are not able to perform them, please contact the Branch Manager to discuss.
Signature
Date
MM slash DD slash YYYY
VOLUNTARY SELF-IDENTIFICATION
FLOIRDA CONCIERGE HOME CARE is committed to equal employment opportunity for all employees/Independent Contractors. As a federal contractor, the Registry isrequired to take affirmative action to employ and advance in employment women and minorities, disabled individuals, disabled veterans and veterans of the Vietnam Era. To assist the Registry in properly identifying its employees and applicants, we request that you complete the following information. Completion of thisform isstrictly voluntary.
Please identify yourself as one of the following:
SEX
Male
Female
RACE
African American
Asian / Pacific Islander
Hispanic
White – Non Hispanic
Two or more races
Other
RELIGION
Christian
Jewish
Muslim
Other
DISABLED OR VETERAN STATUS
I am a Disabled Individual
I am a Disabled Veteran
I am a Vietnam Era Veteran
I am Other Eligible Veteran
None of the above
Other (please specify)
Other (please specify)
Name
Date
MM slash DD slash YYYY
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