Page 1 of 17
GALA – Elder Care Intake Form
Help us understand your care needs so we can match you with the right care provider or care home.
Section 1: Care Type Needed
What type of care are you looking for?
*
(Select all that apply)
What type of care are you looking for?
Care providers (personal support workers who come to you)
Care homes (retirement, assisted living, nursing homes, inclusive later life living/community-based small homes, or respite stay)
Other
Next
