Clients

Lemory Senior Care is the best, most affordable way to find quality Orange County in-home caregivers.

Highly-qualified and trained Orange County caregivers are ready to help you and your loved ones with a variety of daily activities. Please fill out the following Client Inquiry form to help us get to know you as well as the needs of your loved ones.

CLIENT & CONTACT PERSON

Client Name*

Client Phone*

Referred By*

Decision Maker*

Relationship to Client *

Contact Person*

Contact Phone*

Contact Email*

Client Street Address*

Client City*

Services Needed*
 Companionship Meal Preparation Light Housekeeping Errands & Transportation Personal Care & Bathing Medication Management Couples Care Memory Loss Care 24-Hour Care Overnight Stays Live-In Care Other (describe in message)

Currently Using*

Is Client Ambulatory?
 Yes No

Is Client Incontinent?
 Yes No

Please share more about the Client