Which Service Do I Need? Step 1 of 2 50% Choosing the right health care service for yourself or a loved one can be challenging. With that in mind, Liberty Healthcare and Rehabilitation Services has developed this short questionnaire to help us with assisting you determine what may be the right choice. How often does the patient need medical care?*24 hours a dayNo more than a few hours a dayMore than a few hours; less than 24 hours a dayIs the patient's condition life-limiting?*YesNoHas the patient had a recent hospital stay?*YesNoDoes the patient prefer living in a social setting with other of similar ages and backgrounds?*YesNoDoes the patient have a new medical condition, exacerbation of a previous medical condition, recent fall or recent surgery?*YesNoHow far can the patient walk?*100 Feet50 FeetWould the patient benefit from services such as physical therapy, speech therapy, or occupational therapy?*YesNo/Not SureHas the patient received physical therapy, speech therapy, or occupational therapy since the beginning of the year?*YesNoWould the patient benefit from advanced wound care, or other similar treatments?*YesNo/Not SureWould the patient benefit from medication monitoring?*YesNo* = This is a required field Before we proceed, tell us a little about yourself.I am interested in care for:*Family MemberFriendMyselfI am seeking care in the North Carolina zip code of:*Name* First Last Email Phone*Name of Person Requiring Care* First Last Please let us know how we can help:* = This is a required fieldPhoneThis field is for validation purposes and should be left unchanged.
