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Request for Services

Could you benefit from our services? Are you a caregiver who needs a break from the 24/7 demands of your role? Do you need assistance with daily tasks or companionship? If so, let us hear from you. We may be able to help if you are in greater Houston, or direct you to other service providers.

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About You
Your Need For Care

Alzheimer’s or Dementia

Physically Disabled Adult (Advanced Age, Trauma or Disease)

Special Needs Child and Family

HIV/AIDS

Professional Assistant Program

Caregiver Support Group

Caregiver Education

Creating a Caregiving Ministry

Other or General Information (Please Specify in “Your Communication”)

Your Communication
How Did You Hear About Us?

Link From a Website

Magazine/Newspaper Story

TV/Radio News

Referral/Word-of-Mouth/Friend

Caregiver Conference

Congregation

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Interfaith CarePartners

701 N. Post Oak Road, Suite 330
Houston, TX 77024
Tel: 713.682.5995
Fax: 713.682.0639

© 2013, Interfaith CarePartners

Care Team®, Alzheimer’s Care Team®, Second Family Care Team®, Kids’ Pals Care Team®, AIDS Care Team® are registered marks by Interfaith CarePartners®