Getting to Know You - Unique Gift Selections

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Getting to Know You

Welcome

Thank you for taking the time to share a little more about yourself.

The information you provide will help us better understand your preferences, routines, and the type of support you may enjoy. Whether you are completing this form for yourself or on behalf of a loved one, your answers will help us create a more comfortable and personalized experience.

Who will be receiving the service?I will be receiving the serviceI am purchasing this service for someone elsePlease select the option that best describes who the service is being purchased for.

First and Last Name:Name of the person receiving the service. If you are completing this form for someone else, please enter their full name. If you are completing the form for yourself, please enter your own name.

Street AddressPlease provide the address where the services will take place.

Apartment, suite, etc

City

State/Province

ZIP / Postal code

Country

What types of activities or assistance would you enjoy during your visits?Conversation and companionshipSharing coffee or a meal togetherPlaying cards, board games, or puzzlesReading together or reading assistanceGoing for walks or getting fresh airEmotional support and friendly conversationLight household assistanceOrganizing or sorting itemsHelp with errands or shoppingHospital companionshipMeal preparation or assistancePet Care AssistancePriority SchedulingOtherSelect all that apply.

Is there anything else you would like us to know about your preferences, routines, or the type of support you would enjoy?Please share anything that may help us make your visits more comfortable, enjoyable, and personalized. For example, you may tell us about your interests, hobbies, routines, or anything you particularly enjoy.

Are there any accessibility needs or considerations we should be aware of?Please share any information that may help us provide comfortable and appropriate support during visits.

How would you ideally like your visits to be scheduled?1 hour every week — approximately 4 visits per month2 hours every two weeks — approximately 2 visits per monthOne longer visit each month — for example, 4 hoursA different schedule that works better for meI'm not sure yet — I would like help deciding

Please tell us how you would ideally like your visits arranged.For example: two 1-hour visits per week, one 3-hour visit every month, or another arrangement.

Would you like the flexibility to adjust your visit schedule after your first visit?Yes, I would like to discuss adjusting my schedule if needed.No, I already have a preferred schedule.I'm not sure yet.

First and Last Name:Emergency Contact or Family Contact

Phone

How did you hear about us?

Please confirm the following: * *I confirm that the information I have provided is accurate to the best of my knowledge. I understand that this information will help personalize visits and services.

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Like sunshine through a window, kindness has a quiet way of making every day feel a little brighter.

Life is filled with simple moments that become lasting memories: a warm conversation, a shared smile, or the comfort of knowing someone is there.

We believe companionship is about bringing comfort, connection, and a little extra joy to life’s everyday moments.

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