TeleCare Referral Form

TeleCare is a FREE telephone reassurance program that offers a daily connection and supports caregiving services already in place. Our trained Reassurance Specialists provide friendly calls to seniors and/or those with disability.

The TeleCare program aims to reduce isolation, loneliness, and depression, and help people to remain independent in their homes. Specifically, TeleCare offers:

-Emotional support and a friendly check-in
-Medication reminders
-Safety checks

TeleCare provides clients with the comfort of knowing that someone will contact them on a regular basis. It also offers families the peace of mind that their loved ones are being checked on daily. Each client has a safety plan in place and a designated contact is alerted if we are unable to reach a client by telephone.

TeleCare calls are made 365 days a year between 7am and 10pm. The time and frequency of calls depends on a person’s needs and preferences. If you or someone you know is interested in learning more about TeleCare, please call 315.218.1915 or email telecare@contactsyracuse.org. You may also complete this brief online form and someone will reach out by telephone to follow up.

How did you hear about TeleCare?

If you are requesting service for someone else, please use this space to share your name, contact information, and relationship to the prospective participant.

Participant Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Home Phone

Mobile Phone

Address

Street Address

Street Address Line 2

CityState

Zip Code

E-mail

example@example.com

What is the best time of day to reach you by telephone for follow-up?

What type of supportive call would be most helpful? (you may select more than one)

medication remindersafety checksocial visit

Emergency Contact

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.

Additional Information