Call 800-365-4189
Franchisee Opportunities
Local Visiting Angels Office
Your inquiry has been forwarded to the Visiting Angels Agency Representative below.
Sharon Boschini
Andre Plaza 8035 McKnight Rd #304
Pittsburgh PA 15237
412-366-4860
www.visitingangels.com/northhills

Thank You!

If you would like to provide more detailed information please complete our
Visiting Angels Client Needs Survey:

Please select any services that you believe are required for your loved one: (Please select all that apply)
Homecare (Non-Medical) Hospice Services
Homemaker / Household Services Medication Reminders
Live In Homecare Home Healthcare (Medical)
Companion Services Meal Preparation
Home / Safety Monitoring Assistance with Ambulation or Mobility
Transportation Non-Medical
(e.g. Errands, Shopping)
Personal Care
(e.g. Bathing, Dressing, Personal Hygiene)
Homecare for a Veteran or Surviving Spouse


Who is the loved one that you are interested in getting information regarding eldercare services? (Please select one)







Please provide the following information about your loved one.

Gender:
select
Age:


What, if any, existing medical conditions does your loved one have? (Select all that apply)
ALS Incontinence
Alzheimer's / Dementia Joint Replacement
Ambulatory Problems Macular Degeneration / Low Vision
Arthritis Other Eye Disorders & Diseases
Cancer Osteoporosis
Colostomy Parkinson's
Depression Respiratory Disease
Diabetes Stroke
Hearing Impaired Surgical Recovery
Heart Disease Disease or Condition Not Listed
Quadriplegic None / Unsure


Which of the following best describes your loved one’s current living arrangement? (Please select one)





Do you need or want any of the following Consulting / Advisory Services? (Select all that apply)
Geriatric Care Management Certified Senior Advisor
Legal / ElderLaw Services Senior Financing Options (e.g., Reverse Mortgages, Life Settlements, etc.)


What funding source will you be using as the primary payer for the services? (Please select one)




How much have you budgeted for these "out-of-pocket" expenses? (Please select one)





When would you like services to begin? (Please select one)




Please indicate the number of hours of support services that you estimate your loved one will require. (Please select one)






How would you describe your loved one's feelings about receiving assistance? (Please select one)





Please include any additional information that you think may be helpful.