416-207-3888 hello@carehop.ca

Professional Referral Form

Referral

Patient / Client Information:

Home Address:
Home Address:
City
State/Province
Zip/Postal
Country
Mental status:

Contact Person

Recommendations

Additional Notes / Special Instructions

Referral Information

CONSENT AND PRIVACY NOTICE: *

Frequently Asked Questions

 

What happens after you fill out the referral form?

Thank you for filling out the referral form! A Care Manager will contact the client or client’s contact within 24 hours. An in-home or phone consultation will be conducted to discuss care plan and options. The consultation is free of charge and no obligation. If the client decides to go ahead, a perfect matched caregiver will be assigned and the service can start as early as the next day.

What’s the cost?

The consultation is free of charge and no obligation. The cost of care varies based on client’s condition and the level of caregiver needed. Service can start from as little as $49 per visit or $33.99 per hour. We’ll work with client’s budget and help explore other funding options such as LHIN or insurance.

How do we protect privacy?

Client privacy is a top priority at CareHop. We collect clients’ personal health information under the authority of the Personal Health Information Protection Act, 2004 (PHIPA). All CareHop personnel sign a confidentiality agreement and are educated on protecting client privacy and compliance with Ontario’s privacy legislation. Strict security and audit controls are in place to ensure personal health information is protected