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Pre-Care Assessment Information

Fill out our pre-care assessment below and see if Foothill Home Care is the right agency for your needs.

Client’s Name (person needing care)

City Where Care is Needed

Relationship to Client

Email Address

Phone Number

Best time to reach you?

What type of care is needed? (select all that apply)

physical, mental, and emotional support provided through meaningful conversation and activities based on your loved one’s ability and interests.

help with bathing, grooming, dressing, and toileting.

help with daily chores, tidying the home, grocery shopping, and meal preparation.

safe transportation to appointments, errand running, special events, or a variety of other activities.

a break for a family member caregiver or other caregiver.

specialized care for those with memory loss.

What day of the week do you need care? (select all that apply)

What schedule best fits your needs?

Important Schedule and Pricing Information

At Foothill Home Care we utilize a structured scheduling system to provide consistency and reliability for our clients. A variety of schedule options are available from 7am-7pm Monday – Saturday, with a shift minimum of 4 hours/day. At Foothill Home Care we do NOT provide 24/7 care and require that a plan is in place to keep clients safe during non-caregiving hours. The hourly fee for our services is $38 and a 2 week refundable deposit is required before care can begin.

I have read and understand the minimum hour requirements, scheduling options, initial deposit requirement, and hourly fee of Foothill Home Care.  

Responsible Person

If Foothill Home Care is the right agency for you, you will receive a phone call from our Care Coordinator shortly. If you’d rather call us right away, our number is 909-360-1713

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Where Professional Care Feels Like Family

OFFICE HOURS

Mon - Fri 8:00am - 5:00pm

Sat 8:30am - 3:00pm


Serving Rancho Cucamonga, CA
and surrounding areas.

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