La Porte, Indiana
1719 State St c, La Porte, IN 46350
(219) 362-9800
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Comfort Keepers La Porte, IN

1719 State St c
La Porte, Indiana 46350
(219) 362-9800

Home Care Questionnaire

About Your Loved One

Choose the following statements that apply to your loved one:

Does your loved one wear dirty clothing or the same outfit day after day?
Is it apparent your loved one is not showering or bathing?
Is your loved one losing weight?
Are there signs of confusion such as not knowing the date, where he/she is, or the season of the year?
Do the refrigerator or cupboards contain outdated food; or lack nutritious food?
Is the home cluttered or have mail, newspapers, bills accumulated?
Are you finding expired medications or medications that are not being taken?

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La Porte Office

1719 State St c La Porte, Indiana 46350
Call (219) 362-9800

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This is what elevating the human spirit looks like, and we are proud to live our mission every day.

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