Client Application Form

  • Royal Homecare

  • Client Application Form

  • I explicitly consent, or I act as a third party with the legal right to make decisions on behalf of the applicant (eg under a Power of Attorney) to the medical questionnaire and Sensitive Personal Data (including any data in it about physical and mental health) being processed by Royal Homecare Limited for the purpose of providing its services. You are free to refuse to give consent, or to later withdraw consent.*
  • How did you find out about us?*
  • Type of Service*
  • What date do you require the carer to start?
     - -
  • Format: (000) 000-0000.
  • Preferred Contact Method*

  • Client Information

    This is all information relating to the individual(s) requiring care

  • Client's Personal Information

  • What is the client's marital status?*

  • Client(s) Medical Information

  • Care Information / Requirements

  • How long does the client(s) require a caregiver for?*
  • What level of experience do you require the caregiver to have?*
  • Do you require a male or female caregiver?*
  • Do you require a caregiver that can drive?*
  • Would you and the client accept a carer that smokes? (only outside the house)*
  • How many days do you require the caregiver to work?*
  • What days do you require the caregiver to work?*
  • How many hours per week do you require?*
  • What Tasks / Duties are required?

  • Live-in / Respite Care Section Only

    If you are unable to send photos of the house in this application, please email them to info@royalhomecare.ie
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  • Royal Payroll Services

  • Do you require Royal Payroll Services*
  • Would like to be added to the Royal Homecare mailing list for news, updates and marketing*
  • Should be Empty: