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Applicant Information
Name(Required)
First Last
Date of Birth(Required)
Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number(Required)
Email Address
Enrolled in MassHealth?(Required)
- Yes
- No
- Unsure
Need assistance with any of the following? You may select more than one.(Required)
- Select All
- Bathing
- Dressing
- Toileting
- Mobility
- Being Fed
Currently lives with a Caregiver?(Required)
- Yes
- No
If you are completing this form for someone else, please complete the following:
Your Name
First Last
Your Phone Number
Your Email Address
Your Relationship to the Applicant:
Next Steps
Who should be contacted to arrange an intake appointment?(Required)
First Last
Phone(Required)
How did you hear about us?(Required)
- Referral/Word of Mouth
- Social Media
- Google Ad
- Newspaper Ad
- Other
Email
This field is for validation purposes and should be left unchanged.

Name(Required)
First Last
Address(Required)
Street Address Address Line 2 City State ZIP Code

Note: You must reside in Massachusetts.
Phone Number(Required)
Email Address
Do you have a spare bedroom?
- Yes
- No
Briefly explain your caregiving experience:(Required)
How did you hear about us?(Required)
- Referral/Word of Mouth
- Social Media
- Google Ad
- Newspaper Ad
- Other

Caregiver Connections: Shared Resources

Caregiver Connections: Shared Resources

March 2023 Caregiver Connections Resources

For helpful information regarding your MassHealth Redetermination and what you should prepare or disclose, click here.

February 2023 Caregiver Connections Resources

Here are some Mind and Body Relaxation and Sleep Exercises from Yoga Instructor Janet Green Garrison

January 2023 Caregiver Connections Resources

Hands-only CPR Instructional Video (watch this version if you want a laugh)

AED Instructional Video

AED Instructional Video for All Ages

November 2022 Caregiver Connections Resources

10 Tips for Caregivers During the Holidays

150+ Household Uses for Vinegar

October 2022 Caregiver Connections Resources

The Alzheimer's Association

September 2022 Caregiver Connections Resources

Fall Prevention Checklist

Fall Prevention Exercises

Bathroom Grab Bars

August 2022 Caregiver Connections Resources

Finding Local Food Pantries

Searching for Local Thrift Stores

EBT Scams in Massachusetts

Tips on Avoiding Scams

Address

Adult Foster Care of the North Shore
63 Middle Street
Gloucester, MA 01930
978-281-2612 | Toll Free: 866-751-2616
info@adultfostercarens.com
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Who We Are
How We Help
Caregivers
Professionals
Did You Know

Hours

Office Hours Monday – Friday 9:00 am- 5:00 pm
After hours please call 978-281-2612 for assistance.

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