Pre-Registration - Household Service Scheme

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Please fill out this form and we will contact you within 1 working day

Name *

Phone number *

Email address

What is your preferred mode of communication? (Phone Call vs Text vs Email, convenient hours)

What is the condition of the elderly who needs care ? *

Please let us know your needs *

I need help for my elderly loved one on regular basis (e.g.: every Mondays all day and Friday morning for the rest of the year)

I need help for my elderly loved one on ad'hoc basis (e.g.: i need full-time help for 3 weeks while my helper is on home leave)

I will need help on half - day basis (e.g. : Morning or Afternoons)

I will need help of full - day basis

I will need help on full - night basis

Other:

Required

What type of tasks would you like the HSS Staff to do? (Advanced care tasks such as tube-feeding, cleaning of stoma bag, tracheotomy care etc. are NOT allowed under this pilot)
*

Personal Care tasks, including bathing, dressing, toileting, etc.

Oral feeding

Light Housekeeping

Running simple errands like going to market

Assistance with Medications (prescribed by a Medical Professional)

Mind-stimulating activities, companionship

Going on walks and other recreational activities,

Simple exercise

Other:

Required

Are you already a client of Active Global ? for which service? who is your usual contact?

Any additional information which you would like to share with us. If you already know the dates and times for which you need the service, please give us the details here.

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