Let's Get Started: TGCA

Let's Get Started

The Good Companion Home Care
We’re so glad you’re here. This form is designed to help us get to know you—your preferences, routines, and what matters most to you—so we can provide care that feels personal, respectful, and truly supportive.

Your comfort, safety, and independence are our top priorities, and your responses will help us tailor our services to meet your unique needs.
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Hour MinutesAM/PM Option
Getting to Know You & Your Loved One
Your Name:

First NameLast Name
Your Relation to the Person Needing Support:
Your Phone Number:
Your Email:
example@example.com
Person's Name:

First NameLast Name
Person's Date of Birth:

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Region:
Address Where Care is Required:

Street Address

Street Address Line 2

SuburbState

Postal / Zip Code
Town/Suburb

Point of Contact

This is the person we will communicate with to arrange support services
Name

First NameLast Name
Contact Number:
Communication Email:
This is the email address we will use to communicate with you on all matters relating to support services.
Preferred Availability:
When is the best time to contact you to discuss next steps?

Thank You!
Thank you for taking the time to share with us. We look forward to connecting with you soon and supporting you or your loved one.

A Service Coordinator will reach out to you shortly to discuss the next steps.

The Good Companion Home Care Team
Should be Empty:

Let's Get Started