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Please complete the following form and submit it to us to insure your FREE LISTING will appear correctly in The Caregiver Sourcebook.

If you have any questions about filling out this form, please contact us, call 1-888-AGEINFO (243-4636) or call 716-693-3554.

* denotes required field

1. If applicable, please fill in parent company information. Otherwise go to #2.
Parent Company/Organization:
Address: City:
State: Zip:
Telephone: Fax:
Web Site: Toll Free:
E-Mail: TTY/TTD:
Contact: Title:

 

2. Please fill in this section for free listing information.

Company/Organization*:
Program Name:
Address*: City*:
State*: Zip*:
Telephone*: Fax:
Web Site: Toll Free:
E-Mail*: TTY/TTD:
County Location*: Counties Served*:
Contact*: Job Title*:
Telephone*/Ext: / Fax:
* Not for Profit     For Profit     Government Agency

 

Please mark the categories under which your listing should be found
Abuse - Alcohol/Substance
Programs and services designed for alcohol and substance abuse.
Home Repair / Safety / Maintenance
Programs and services that provide physical and/or financial assistance for home repair and maintenance.
Abuse - Elder/Domestic
Programs and services designed for elder and domestic abuse
Hospice
Organizations that provide a coordinated program of home and inpatient care for the terminally ill.
Adult Day Care - Medical / Mental / Developmentally Disabled
Social programs with medical assistance.
Hospitals / Clinics / Healthcare Centers
Listed by county location.
Adult Day Care - Social
Social
Programs and services designed for stimulation with supervision.
Housing - Adult Home
Non-medical independent housing with minimal supervision.
AIDS/HIV
Support programs and services for individuals diagnosed with AIDS/HIV and their families.
Housing - Assisted Living
Facilities providing limited medical assistance.
Alzheimer's / Dementia
Support programs and services for individuals diagnosed with Alzheimer's/Dementia and their families.
Housing - Continuing Care Retirement Community
State regulated Continuing Care Retirement Communities.
Behavioral Health
Providers of mental health counseling, intervention, and support services.
Housing - Developmentally Disabled
Housing designed for developmentally disabled individuals.
Blind and Visually Impaired Services/Products
Programs, products, and services developed to assist the blind and visually impaired.
Housing - Enriched
Apartment living with some assistance.
Case Management Services
Individual needs assessment and connection to services.
Housing - Independent / Retirement
Living spaces designed for mature adults without supervision.
Companions / Friendly Visiting
Volunteer programs that provide companionship for the homebound.
Housing - Memory Impaired
Housing designed for individuals with Dementia and Alzheimer's disease.
Deaf and Hearing Impaired Services / Products
Programs, products, and services developed to assist the deaf and hearing impaired.
Housing - Nursing Facilities
Skilled nursing facilities.
Durable Goods - Daily Living Aids Providers of products that enhance "quality of life" such as: specialized clothing, wheelchairs, walkers, medical equipment and supplies etc. Housing - Rehabilitation / Subacute Care
Housing that provides transitional care between hospital and home when short-term therapy and rehabilitation is needed.
Housing - Rental Assistance
Subsidized senior/disabled housing.
Durable Goods - Pharmaceutical / Infusion Therapy
Providers of prescription and nutritional solutions for intravenous users
Information / Referral
Providers of information and/or linkage to services.
Financial Assistance
Programs that provide subsides, employment opportunities, and financial counseling
Insurance - HMO/Long Term Care/Supplemental
Providers of insurance products directed to the mature market.
Food and Nutrition Programs / Sites
Subsides, congregate meal sites, home delivered meals, emergency food services.
Legal Services
Listings of companies and programs that offer legal counseling and assistance.
Geriatric Care Management
Specialized elder care assessment and supervision wth linkage to service providers
Personal Emergency Response Systems
Listings for telephone systems designed to summon help in the event of an emergency.
Geriatrician
Licensed physicians with special training or interest in geriatrics.
Protective Services
Listings that provide adult protection programs.
Government Programs
Federal, State, County and City run programs designed to assist caregivers and their care recipients.
Respite
Support services that provide time-off for the caregiver.
Guardianship
Programs and individuals that are legally qualified to appoint guardians for the purpose of managing an incapacitated individuals wishes.
Supportive and Assistance Organizations (non-health related)
Non-medical supportive programs and services for adults/mature market.
Health Support Services and Associations
Primarily non-profit health related organizations and advocacy groups.
Senior Centers / Membership Organizations
Social, recreational, advocacy, and volunteer organizations.
Holistic Health
Products, services and programs utilizing the natural approach of healing by tapping into the body's natural healing mechanism through nutrition, detoxification, and meeting the individual's needs on the physical, emotional and spiritual plane.
Telephone Assurance Programs
Telephone programs designed to verify well being through regular calls.
Transportation
Listings for medical and non-medically related transportation.
Home Care / Non-medical
Non-medical home support services.
Utilities
Utility related programs, services, and subsides.
Home Health Care
In-home health care utilizing home care aides and medical professionals.
Veterans
Listings of services and programs to assist Veterans.
Other
Explain:
                            

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