Elder Care Services

Click above for detailed listing of services

To receive additional information about our services, or to arrange a complimentary service consultation with a Dubols Home Care professional, feel free to call, email, or submit your request using the Confidential Request Form below.

All requests will be held in the strictest of confidence and will not be shared with any 3rd party.

Please fill out all fields for an accurate response. Thank you!

Name (First name/Last name): Current Residential Address: City:     State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    Zip: Email: Day phone:     Best time to call: Evening phone:    Best time to call: When would you like the Care Provider to start? What type of Care Provider Services are you interested in?        How old is the adult involved? Can he/she speak English? Yes No          If no, what language does he/she speak? Can he/she walk? Yes No Does he/she have any ongoing medical condition? Yes No     If yes please explain: Is he/she on any medication? Yes No     If yes, please explain: What are some of the recipient's health issues?     Medical Health Conditions:   Heart Disease   COPD   High Blood Pressure         Stroke    Cancer      Dialysis     Oxygen     Hospice     Ambulation:   Self-Ambulatory    Ambulatory with Assistance   Non-Ambulatory         Cane/Walker   Wheelchair     Fall Risk     Bed Bound     Diabetes:     Diabetic     Oral Meds     Insulin Dependant     Self Injects     Elimination:     Continent     Incontinent     Bowel    Bladder only Catheter         Colostomy Bag      Full Briefs/Pull Ups Pads     Mental Status:  Alert Confused     Dementia     Alzheimer's    Depression         Bi-Polar   Combative     Wanders Off     Awake PM     Body:  Physical Therapy   Fractured Hip/Leg   Occupational Therapy         Arthritis       Scoliosis      Paralyzed Other conditions or information not listed above:                Enter recipient's e-mail: