Contact
Information
Form

Caretech, Inc.
"Helping people remain in their own home."
Serving Iowa and Nebraska

   

Contact Information and Form

Office Locations
Omaha:  11904 Arbor Street, Ste. 201, Omaha, NE 68144
Council Bluffs:  1520 Ave. M, Council Bluffs, IA 51501

Phone# (402) 697-5121
Toll Free: (800) 991-7006
Fax# (402) 330-3411
Email Caretech
Return to Caretech Home Page

The following information is confidential and will only be used to help determine the best plan of care.  A manager will contact you shortly.
Please click the "Submit" button at the bottom of the page after completing the form.  Thank you.

*indicates required fields.
Name*      
Address*      
City*   State*   Zip*  
Phone #    Email Address  
I am requesting information for
Please contact me via Phone.
Please contact me via Email.
Please send me a Brochure.

Please place a check mark (by clicking the box) next to those areas currently needed:
Companionship/Respite Care Meal Preparation/Assistance
Transportation Errands
Vacuuming/Mopping General Cleaning of Kitchen/Bath/Living area...
Bill Preparation Letter Writing
Laundry and Folding Bedding Changes
Reading Help Cleaning Dishes
Walking Assistance Toileting Assistance
Bathing Assistance Scheduling Appointments
Pet Care Assistance Mail Review
Take Out Garbage Lifeline Personal Emergency System

Please describe the current health concerns and living situation of the person(s):

 

 
© 2005 Caretech, Inc.