Application for working caregivers help


We want to help you by freeing some time for you in your life. (If you reached this page looking for our info on a caregiver job click this).

To search for a caregiver job or a caregiver click this.)

The purpose of this application is to help you with us to see how effective we can be in helping your loved one.
The information will be kept confidential.

If you have any questions feel free to call now
(1-USS-4-GET-ME-NOT). This form is free to fill in. The agreement is needed to begin services. We do look forward to having an opening at your desired time. We will contact you if we have any questions.
There are some required (*) information boxes. Completeness determines prompt service. To help your parent maintain senior independent living and to keep them alive as well as out of the hospital and nursing home please do not delay your application. If you would like to get a more visual look at the application information you may download PDF application file here.

Our main focus is on preventing unnecessary deaths, and nursing home and hospital admissions by assuring prescription drugs being taken as prescribed. We can talk about medications. We are willing to help in related areas over the phone or through the mail. In the event of a medical emergency we will perform your wishes. Depending on the health status and physical abilities we can assist to a certain extent.

If we needed to contact Emergency Medical Services (EMS) their local contact number is needed because "911" is not the same in all areas of the country. We need to have the local EMS number(usually the loved ones' local Police Department including the area code). If there are any allergies to drugs and EMS needs to know we can inform them on your behalf. If they have a medic alert id we can tell EMS what type to look for. We call it your definition of an emergency
Which is similar to
This picture will link to another site to help when you may not be able to speak or prefer another method for help-

If you want to keep the information private it is okay.
Just like the question about an advanced medical directive or (POAHCD)

Power of Attorney Health Care Directive

or living will again in the case of an emergency, as well as the primary physician to be contacted.

The application requests for information about nearby contacts just in case it is not an emergency (as you define it or we perceive it) to contact a nearby neighbor can be very helpful especially one who is entrusted with a key.
The special services are designed for us to make contact for you during business hours if we are permitted to.
It depends on the individual circumstance if a power of attorney is needed.
Again that is why we ask so many questions just to help you and your loved one. We have found a few websites that we would recommend for you to look at for further help and guidance.
This site is sponsored by Personal Voice Inc.

To summarize the areas of benefits and opportunities.
1, To establish a relationship with your loved one.
2, To assure both you and your loved one of your care and concern,
3, Establishing a routine to be expected on morning, noontime and evening.


Please note that all fields followed by an asterisk must be filled in.

Why are there so many questions?
Whether there is a need for a wakeup call,
check blood pressure or blood sugar,
ensure medications, appointments, diets,
meals on wheels, visiting nurse, homemaker, elder daycare,
vitamins, fiber or herb supplements,
exercises in various forms,
dance, Tai Chi, Yoga Martial arts, weight bearing, walking,
elder care, transportation, Senior center activities,
shopping, entertainment.
We want to be the most comprehensive service for your loved one. To continue the process go to
The agreement
or look below

Agreement by Personal Voice Inc. Your Forget-me-not Service in the Computer age

Please note that all fields followed by an asterisk must be filled in.

with any button below.
You will be taken to a secure PayPal page.

Prepay monthly service=10% discount
SILVER SERVICE $88.00=only $79.20
1 Minute call length
15 calls/week -

Prepay monthly service=10% discount
GOLD SERVICE $200.00=only $180.00
3 Minute call length,
15 calls/week

Prepay monthly service=10% discount
PLATINIUM SERVICE $340.00=only $306.00
5 minute call length
15 calls/week

This Button is for a $60 Service
Deposit if you want the $60/hour
Fun Services.
or Special Services
Billed in 15 minute increments.

Fast Feedback To Us
or Call 1-877-443-8636-1-USS-4-GET-ME-NOT

Please note that all fields followed by an asterisk must be filled in.

Please enter the word that you see below.