WHAT IS TELECARE?

Telecare is a service through which A Better Way makes daily calls to older, disabled, or homebound adults. We offer a friendly voice to help brighten our clients’ days, as well as comfort in knowing that someone is checking in on them. Telecare provides comfort and joy not only to those being called, but also to their loved ones, knowing that someone is checking in each day.

There were days when I would’ve forgotten my medicine, and Telecare has been really helpful for me.

Garla

Medication Reminder

I like how uplifting and giving everyone is at Telecare. Staff are always there to listen.

Julie

Social Call

I like Telecare! It’s nice to have someone who cares to check on me every day!

Charles

Safety Check

ADD YOUR LOVED ONE TO TELECARE!

Client Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

County of Residence(Required)

Other County(Required)

Home Phone(Required)

Cell Phone

Demographic Data

The following data is not used for eligibility for the Telecare Program.

Date of Birth

Gender(Required)

Female

Male

Other

Ethnicity:

African American

Asian

Caucasian

American Indian

Hispanic

Other

Contact Information

Telecare calls are made between the hours of 8:00 a.m. and 5:00 p.m. Monday through Sunday. Please indicate the times you would like to be called. You may have up to three calls per day.

I want my Telecare calls to begin on this date:(Required)

Please indicate what day(s) of the week you would like to be called.(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Call Times(Required)

Up to three calls are available from 8AM-5PM, Monday through Sunday.

Other Information:

Please check all that apply.

Please call for:(Required)

Social Call

Safety Check

Medication Reminder

Please:(Required)

Do NOT call back if I am not reached.

Do NOT call the police if I am not reached.

Call back every 15 minutes if I am not reached.

Call contacts if I am not reached after 1 hour.

Client Notes

In the space below, please write any issues that need checked on:

Medical History

Please indicate any family history or medical issues in the space below:

Hobbies

In the space below, please write any interests or hobbies you have:

Preferred Contact Information

Emergency Contacts (list up to three contacts)(Required)

First Name

Last Name

Relationship

Home #

Cell #

Work #

Click the (+) button to add additional contacts.

How did you hear about Telecare?

LifeStream

A Better Way Website

Church

Hospital

Community Presentation

Other

Would you be interested in additional services through LifeStream?

Comments

This field is for validation purposes and should be left unchanged.

A Better Way, Muncie
Office: 765-747-9107
P.O. Box 734 Muncie, IN 47308
Fax: 765-281-2740

A Better Way, Richmond
Office: 765-966-0538
15 S. 11th St. Richmond, IN 47374