Request FOR SERVICE Form

All-Island Home Care Services

60 East Industry Court (4th Floor, Suite B) Deer Park, New York, 11729

----------------

Check types(s) of services needed and submit

(For skilled Nursing Assessments, all types of IV Antibiotic Infusion in your home).

LPN

(For wound care treatment, wound-vac or diabetic monitoring and care).

H.H.A

(Home Health Aide, medication reminders, feeding when necessary and other specialized care for our clients).

Companionship

Live-In or Live Out

PT / OR / OT

(Physical Therapy, for your daily exercises and muscle strength).

Social Worker

(For general advisement, Insurance and financial issues).

Other

(Please explain if not listed above).

I Attest that the information I provided is true and correct, and it will be verified.

When you apply, All-Island Home Care Services will collect and use personal data about you during the process. Your personal data may be retained and used by All-island Home Care Services for the purpose of contact for your service requested, as required by law.

All-Island
Home Care Services

Hours of Services

Request FOR SERVICE Form

All-Island Home Care Services

60 East Industry Court (4th Floor, Suite B) Deer Park, New York, 11729

Check types(s) of services needed and submit

(For skilled Nursing Assessments, all types of IV Antibiotic Infusion in your home).

(For wound care treatment, wound-vac or diabetic monitoring and care).

(Home Health Aide, medication reminders, feeding when necessary and other specialized care for our clients).

(Physical Therapy, for your daily exercises and muscle strength).

(For general advisement, Insurance and financial issues).

(Please explain if not listed above).

Questions? Let us know how we can help you

Send a contact request today, we'll get back soon (normally within 24 hours).

Request for Service Form

Hours of Services

Request FOR SERVICE Form

All-Island Home Care Services

60 East Industry Court (4th Floor, Suite B) Deer Park, New York, 11729

Check types(s) of services needed and submit

(For skilled Nursing Assessments, all types of IV Antibiotic Infusion in your home).

(For wound care treatment, wound-vac or diabetic monitoring and care).

(Home Health Aide, medication reminders, feeding when necessary and other specialized care for our clients).

(Physical Therapy, for your daily exercises and muscle strength).

(For general advisement, Insurance and financial issues).

(Please explain if not listed above).

Questions? Let us know how we can help you

Send a contact request today, we'll get back soon (normally within 24 hours).