General 1 — The Vaughn Agency

Safe Worry-Free Service with a Smile

SCHEDULE A FREE CONSULTATION NOW

The Vaughn Agency is committed to being the preferred trustworthy non-medical home care and mental wellness agency throughout NC. We strive to positively impact our community by always exemplifying respect, excellence, and professionalism.

Please complete the following form and a representative from our Care Team will contact you to schedule your upcoming consultation.

Your Name

The Person who is completing the application.

First Name

Last Name

Address where services will be provided

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Client Name that Needs Services

First Name

Last Name

Client Email

Client Phone

(###)

###

####

Client Date of Birth

MM

DD

YYYY

What services are needed now?

Bathing

Dressing

Grooming

Meal Prep

Light Housekeping

Mobility Assistance

Please provide more detailed information about the condition of the client

Preferred Start Date

MM

DD

YYYY

How did you hear about us?