Join Our Growing Staff At LifeStyle Options, Inc.
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Make a referral or request information 

Service Areas:
Chicago,Chicago Suburbs, Cook County, DuPage County, Will County, Kane County, Lake County, McHenry County, Winnebago County, Boone County, DeKalb County, & Champaign County

Hours of Operation:
24 Hours a Day, 7 Days a Week

 


Member

 
When your care is what matters, there's only one option...
Call Us at (888) 342-INFO (4636)                Since 1989

Referral/Request Information


REFER YOURSELF OR FAMILY OR A PATIENT
Now in our third decade, LifeStyle Options Inc. is a leader in providing exceptional, high quality home care services. To make a referral, simply complete the brief referral form. One of our Care Managers will call you during the next business day. To make absolutely certain we have captured exactly what you or your family member needs, we encourage you to complete this Plan of Care form. Should you prefer an in-person visit, simply call our office to schedule a no-cost, no obligation care conference.
Referral made by
   
Your Name
 
Your Phone
 
Relationship to Client
 
Your E-mail
 
Client Information   
Name
 
Marital Status
 
Address
 
City
 
State
 
Zip
 
Phone
 
Date of Birth
 
Type of Service Requested
 
   
Level of Care Requested
 
Select All That Apply  
Goals 
Promote Independence Promote Hygiene
Ensure Safety Assist with Ambulation
Assist With Nutrition Encourage Socialization
Emphasize Orientation Assist with Medication
Other
 
   
Mental Status  
Problem with Memory Problem with Moods
Problem with Sleep Oriented
Forgetful Withdrawn/Depressed

Notes
 
Personal Care Needs 
Bathing/Grooming Incontinence Care
Dressing Skin Care
   
Other Care 
Medication Reminders? Meal Preparation?
Housekeeping 

Notes
 
   
Environment  
Smoking Household? 
Pets?
 
Who Should we Contact?   
Name
 
Relationship to Client
 
City
 
State
 
Zip
 
Phone
 
E-mail
 
Cell Phone