Senior Care Home Options will match your loved one's personality with a care
facility that best suits him or her. We achieve this by interviewing your family and your
loved one through our professional evaluation process.

Each care facility SCHO works with has been through an extensive facility questionnaire
and had personal visits by SCHO staff.

Please feel free to contact our 24-hour office at 916-835-3944.

Or complete the form below to receive more information.

We will respect your private information and not release to any unrelated third parties or advertisers.

Fields with * are required.

First Name*
Last Name*
Contact email address*
Contact primary phone number*
Contact alternate phone number*
Name of person receiving service (Optional)
Relationship to person who will be receiving service*	<Please select> Daughter Friend Grand Parent In-Law Parent Self Son Other
Age of person who will be receiving service*
Please select type of Service provider needed*	Adult Day Care  Alzheimer's Care Facility  Assisted Living Facility  Case Management  Companion Services & Home Assistance (Meals, Laundry, Companionship, Run Errands)  Emergency Response Systems, Montoring Systems  Group Home  Home Health Care - Medical (Wound Care, Med Admin, Tube Feeding, Ostomy etc)  Hospice  Nursing Home Services  Personal Care (Bathing, ADLs, Medication Reminder, Help with Hygiene etc)  Physical Therapist  Rehabilitation Center  Respiratory Therapist  Retirement Community
In which city will care be provided?*
Service recipient's current medical condition*	After Surgery Care  Alzheimer's/Dementia  Arthritis  Cancer  Diabetes  Incontinence  MS  Parkinson's  Respite Care  Stroke
Other medical condition(s), please describe
Number of service hours needed per week*	<Please select> 1-10 hours 11-20 hours 21-30 hours 31-40 hours More than 40 hours
How will you be paying for this service*	Long Term Insurance Medicaid Medicare Private Funds Private Funds & Medicaid (Combination) Private Funds & Medicare (Combination)
Other payment type, please specify
When is this service needed?	<Not selected> Now In a week In 2 weeks In 3 weeks In 4 weeks In More Than 4 Weeks
Other time, please specify
What is your weekly budget?*	<Please select> Less than $500 $500-$1000 $1000-$1500 Over $1500
How will you like to be contacted?*	<Please select> By Phone By Email Either
Any additional information