Get Your Customized Care Plan

Ensure the best care for your loved ones with a plan designed just for them. Fill out the form, and we'll send a personalized care plan tailored to their unique needs and preferences within 24-48 hours.

Want to learn more about our care services? Visit our websiteAnaya Care

Name of Client

Phone Number

Date of Birth

Contact Information

Contact Name

Contact Phone Number

Contact Email

Activities of Daily Living (ADLs)

Bathing

Dressing

Toileting

Transferring

Eating

Instrumental Activities of Daily Living (IADLs)

Meal Preparation

Housekeeping (cleaning, laundry, etc.)

Shopping (grocery, errands, etc.)

Managing Medications

Transportation (driving or arranging transport)

Communication (making calls, handling mail)

Mental and Cognitive Health

Does the client have memory issues?

Does the client have cognitive impairment?

How would you describe the client's emotional state?

Social Support

Are there family members who can provide support?

Does the client belong to any community groups or organizations?

Specify the social activities the client enjoys.

Preferences and Goals

What daily routines does the client prefer to follow?

What hobbies or activities does the client enjoy?

What goals does the client want to achieve with their care?

Safety Assessment

Does the client feel safe in their home environment?

Are there any hazards in the client's home? (e.g. stairs, clutter, etc.)

Does the client have an emergency plan in case of an incident?

Caregiver Support

Does the client have a primary caregiver?

Does the caregiver need additional support or respite?