Request Service

Client Profile (Receiver):


Mr.Mrs.Miss.Ms.







Primary Caregiver Information (if applicable):



WorksRetiredAt Home






Client Information:

   

CE-LHINCommunity Support AgencyFamily/FriendPhysicianGAIN ClinicHospitalLong-Term CareODSPOntario WorksSelfSocial MediaVeterans AffairsOther

Private Home / Apt.Rented Room/Group HomeAssisted Living /Supportive Housing

AloneWith Spouse/Partner onlyWith Child onlyWith Parent/GuardianWith SiblingsWith Other RelativesWith Non RelativesWith Spouse/Partner and Child


Services Required:*

Our essential services are ongoing and we are dedicated to providing support during the pandemic. In the short-term, we have suspended non-essential services to diminish the risk to our clients, staff and volunteers.

Access to Primary Care (Personal Support Worker accompanied transportation to medical appointments) – Service: OngoingAdult Day Program (Caregiver relief to families and a social outlet for the participant) – Service: In-person Groups Temporarily Suspended, Virtual is OngoingAssisted Living / Supportive Housing (Provide 24/7 scheduled or unscheduled Personal Support Worker services) – Service: OngoingCommunity Food Box (The Food Box contains essential groceries for healthy living) – Service: OngoingCOPE Mental Health Support Groups (Community Mental Health program for adults 16+ with emotional or mental health concerns) – Service: In-person Groups Temporarily Suspended, Virtual is OngoingExercise & Falls Prevention Classes (Group exercise and falls prevention for older adults) – Service: In-person Classes Temporarily Suspended, Virtual is OngoingFoot Care Clinics (Community clinics for people needing assistance with foot care due to mobility, vision, or diabetes) – Service: OngoingFriendly Visiting (Volunteers visit individuals on a regular basis to share activities and companionship) – Service: Temporarily SuspendedHome at Last (Assistance for individuals requiring help to get home and settled upon discharge from hospital) – Service: OngoingHome Maintenance (Brokered home helpers provide outdoor maintenance using client’s supplies and equipment) – Service: OngoingIn-Home Respite (Personal Support Workers offer a break to a caregiver by providing personal care and assistance with daily activities) – Service: OngoingLuncheon Out (Community dining events providing an opportunity to enjoy a nutritious meal and entertainment) – Service: Temporarily SuspendedMeals on Wheels (Volunteer delivers hot and/or frozen meals to the Client) – Service: OngoingTelephone Reassurance (Volunteers call clients on a regular basis for a brief chat and friendly check-in) – Service: OngoingTransportation (Volunteers take clients to and from mainly medical appointments, accessible van transportation is available) – Service: Ongoing