• Immediate Care Request

    Home Care | Medical Escorts | Facility Staffing | Hospital Private Duty

  • Need care as soon as possible?

    Use this form to request information about C-Care’s services. Please note: this is not a service request form. Submitting it does not book or confirm care.

     1. Share your needsComplete this short information form.
     2. We contact youA C-Care representative reaches out to discuss your care needs.
     3. Service Request FormWe send you a separate Service Request Form to complete.
     4. Care is confirmedYour caregiver and schedule are confirmed by phone, email or text.

    Requests received through this form are prioritized and will be responded to as soon as possible.

    For an immediate response or to speak with a C-Care representative, please call 416-724-2273, press #1.

    For medical emergencies, please call 911 or go to the nearest emergency department.

  • How would you like us to contact you?*
  • Format: (000) 000-0000.
  • What service are you requesting?*
  • What assistance is required? Select all that apply.
  • What type of healthcare provider are you requiring?*
  • What type of medical escort are you requiring?
  • What type of Specialized Care are you requiring?
  • Are you requesting this service for:*
  • When do you need service to start?*
  • Preferred Start Date*
     - -
  • How long do you anticipate the need for service?
  • Should be Empty: