Elder Guard | MyParents Care Assessment

Contact Details

Your Name *

WhatsApp Number *

Email Address (Optional)

Country you are currently living in *

Relationship to the patient *

Son Daughter Relative Other

Parent / Patient Details

Parent's Name *

Age *

Gender *

Male Female

Current location in Sri Lanka *

Living situation *

Living alone With spouse With caregiver With family Other

Current Health Condition

Current mobility level *

Walking independently Walking with support Difficulty walking Bedridden

Known medical conditions *

Tick all that apply

Diabetes Hypertension Heart disease Stroke history Dementia / memory issues Recent surgery Depression / anxiety Other

Is your parent currently taking regular medication? *

Yes No Not sure

Any recent hospital visits or major health concerns? *

Emotional & Social Wellbeing

Does your parent often feel lonely, anxious, or emotionally upset? *

Yes Sometimes No Not sure

How often do you communicate with them? *

Daily Few times a week Once a week Rarely

Do you feel they need emotional support / companion care? *

Yes Maybe No

Main Concerns

What are your main concerns right now? *

Safety at home Fall risk Medical monitoring Medication management Loneliness / Emotional stress Emergency support Regular family updates Need someone to visit and check Other

How urgent is this requirement? *

Immediate support needed Within this week Within this month Just exploring

MyParents Care Plans Overview

Below are our MyParents Care plan categories. You do not need to decide now.

After the FREE initial assessment visit, we will recommend the most suitable care plan based on your parent's actual condition.

Which care level do you feel may be suitable? *

Option 1 — Basic Care Plan Light monitoring and reassurance for independent parents.

Weekly check-in calls
Monthly health summary
WhatsApp support
Priority WhatsApp response
Monthly wellbeing check call
Family update summary

Option 2 — Standard Care Plan Regular support with smart medical monitoring.

Monthly nurse visit
BP / sugar monitoring
Health report to family
WhatsApp updates
Remote doctor monitoring

Option 3 — Premium Care Plan Advanced care with direct medical support.

2 nurse visits per month
Monthly doctor consultation
Medication monitoring
Emotional support calls
Detailed monthly report
Priority support

Option 4 — Elite Care Plan Complete responsibility care plan for full peace of mind.

Weekly nurse visits
Full vitals monitoring
Monthly priority doctor consultation
Medication supervision
3–4 support calls per week
Companion visits
Emergency coordination
Home safety assessment
Dedicated care coordinator
Weekly detailed reports
Updates after every visit

Option 5 — Not Sure Please recommend after assessment.

Any special notes we should know before the visit?

Would you like us to arrange a FREE initial assessment visit? *

Yes, arrange a visit Please call me first Not yet

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Thank you!

We have received your details.

Our Elder Guard | MyParents Care team will review the information and contact you shortly to arrange the FREE initial assessment visit.