*

I explicitly consent, or I act as a third party with the legal right to make decisions on behalf of the applicant (eg under a Power of Attorney) to the medical questionnaire and Sensitive Personal Data (including any data in it about physical and mental health) being processed by Royal Homecare Limited for the purpose of providing its services. You are free to refuse to give consent, or to later withdraw consent.

I have read, understood and agree to the processing of sensitive personal data

What date do you require the carer to start? *

MM

DD

YYYY

Name *

Name of the person requiring care

First Name

Last Name

What is the client's marital status?

Single

Married

Divorced

Partnered

Separated

Widowed

What level of experience would you like the carer to have? *

6 - 12 months

1 year

2 or more years

Would you prefer a female or male carer? *

Female

Male

Open to either

Would you and the client accept a carer that smokes (only outside the house) *

Yes

No

Tasks / Duties *

Please tick all that are required.

Preparing / Cooking Meals

Feeding / Eating

Bathing / Showering

Continence Care / Toileting

Dressing / Grooming

Running Errands (picking up prescriptions, post office collection and deliveries, returning books to the library, shopping for clothing etc.)

Grocery Shopping

Light Housework (cleaning common areas, changing bedsheets, laundry, dusting and vacuuming)

Mobility Exercises

Medication Prompting / Monitoring

Transportation (medical appointments, social events etc)

Companionship

How many hours would you like the carer to work? *

Please note that our carers work for a minimum of 30 hours per week to a maximum of 48 hours per week.

30 hours

30 - 37.5 hours

37.5 - 48 hours

What days would you like the carer to work? *

Please note that our carers can work up to 6 days per week but must have a minimum of 1 full day off per week. There is a 10% increase in the carer's salary for working on Sundays.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday (premium 10%)

Do you require the Royal Payroll Service? *

This service is for setting you up as the employer, providing payslips and dealing with all Revenue correspondence (discount for all RH Clients)

Yes

No

How did you find out about us? *

Family/Friend Referral

Google

Newspaper

Radio

Leaflet

GP / Hospital

Church

I would like to be added to the Royal Homecare mailing list for news, updates and marketing and I confirm that I have read, understood and agree to the terms of our Privacy Policy. *

View the privacy policy here.

I confirm that I have read, understood and agree to the Royal Homecare Terms of Service. *