Home Care
Evaluate & Choose
“QUESTIONS TO ASK” WORKSHEET
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The following is a questionnaire for home care services. Use this checklist
when interviewing prospective home care agencies. The services and products
needed to be able to allow someone to live in their home can be numerous and
diverse. This worksheet will help you evaluate whether or not the agencies you
are considering can meet your care needs. Not all questions will be relevant
to your particular situation based on the type of home care needed.
Fill in the information below for each agency/provider. On the following pages, circle Y or N for
each question. This worksheet will give you a direct comparison for each agency/provider.
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