Home Care
“QUESTIONS TO ASK” WORKSHEET
The following is a questionnaire for home care services. Use this checklist when
interviewing prospective home care agencies. The services and products needed to
be able to allow someone to live in their home can be numerous and diverse. This
worksheet will help you evaluate whether or not the agencies you are considering can
meet your care needs. Not all questions will be relevant to your particular situation
based on the type of home care needed.
Fill in the information below for each agency/provider. On the following pages, circle Y or N for
each question. This worksheet will give you a direct comparison for each agency/provider.
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