get started with home care

Complete our Client Information Form below to help us understand your care needs and prepare the documents required to move forward.

There is no cost or obligation to submit the form.

begin the client information form
Get Started With Home Care

a faster way to prepare for care

No cost to submit

Completing the form is free and does not commit you to starting services.

Fewer Delays later

Providing the required information in advance helps our team review your needs, prepare your documents, and respond more efficiently when support is required.

Join our active service list

Once your service documents are reviewed and signed, your information can be securely kept on file so you are better prepared to request care when needed.

pay only when care is provided

Submitting the form, and signing your service plan and agreement does not create a charge. Service fees apply only when care is scheduled and delivered, according to your service agreement.

begin the client information form

Client information form

Please complete this form so our team can better understand your needs and discuss the right care options for you or your loved one.
*For general inquiries, please visit our Contact Page instead.

Client information

Representative information

Power of Attorney information

Emergency Contact information

Family Doctor

What support are you interested in?

Select all that apply.

Services Required
Services Required

Schedule Requirements

Health Information

additional information

Disclaimer Agreement
Marketing Consent

We typically send practical resources, event invitations, and care planning information. We respect your privacy and you may unsubscribe at any time.

What Happens Next?

What you can expect after you submit the Client Information Form.

Provide the information needed to help us understand the client’s needs and requested services.

Our team reviews the submission and contacts you if clarification or additional details are required.

We prepare the applicable service plan, service agreement, and other required documents and send them to you for electronic review and signature.

Once the required documents are completed, your information can be kept active and ready for care coordination.

Call our team when you are ready to schedule care. We will confirm your needs, discuss availability, and coordinate the next steps.

Frequently asked questions

No. There is no fee to complete or submit the Client Information Form.

Fees apply only after services are scheduled and provided, according to the terms of your service agreement.

We prepare the applicable service plan, service agreement, and other required documents and send them to you for electronic review and signature.

Yes. Information submitted through this form is used to review your request, prepare care documents, communicate with you, and support care planning. Access is limited to team members who require the information for these purposes.

Yes. You may complete the form for a family member or another person when you are authorized to provide their information.

Call us at 204-415-3471 and a member of our team will assist you.

No. Being on the active service list helps reduce administrative delays, but service availability still depends on the requested schedule, care needs, location, and available staff.

Stay Connected

Follow Reliable Home Care for caregiving tips, educational resources, community events, and updates.

let’s talk about your family’s care

Whether you’re planning ahead or need support right away, we’re here to answer your questions and help you understand your options. There’s no fees to make an inquiry or obligations to start services.

Phone: (204) 415-3471
Email: info@reliablehomecare.ca
Office hours: 8:30a.m. – 3:00p.m.
*24/7 Contact Availbility
Address: 1320 Portage Ave, Winnipeg, MB, R3G 0V2
Service area: Winnipeg and surrounding communities

Marketing Consent