{"id":328,"date":"2022-08-16T11:37:01","date_gmt":"2022-08-16T16:37:01","guid":{"rendered":"https:\/\/care4seniors.net\/?page_id=328"},"modified":"2022-08-16T12:05:02","modified_gmt":"2022-08-16T17:05:02","slug":"intake-forms","status":"publish","type":"page","link":"https:\/\/care4seniors.net\/intake-forms\/","title":{"rendered":"Intake Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"328\" class=\"elementor elementor-328\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4b52eb2e elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"4b52eb2e\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1837bdfe\" data-id=\"1837bdfe\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-53a331b3 elementor-widget elementor-widget-image\" data-id=\"53a331b3\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 13-03-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/care4seniors.net\/\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"326\" height=\"326\" src=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/06\/specialty-senior-care-logo-transparent-bg-optimized-e1654547177165.png\" class=\"attachment-full size-full wp-image-228\" alt=\"\" srcset=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/06\/specialty-senior-care-logo-transparent-bg-optimized-e1654547177165.png 326w, https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/06\/specialty-senior-care-logo-transparent-bg-optimized-e1654547177165-300x300.png 300w, https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/06\/specialty-senior-care-logo-transparent-bg-optimized-e1654547177165-150x150.png 150w\" sizes=\"(max-width: 326px) 100vw, 326px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-53d3240f\" data-id=\"53d3240f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3c9c3b38 elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"3c9c3b38\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 13-03-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h5 class=\"elementor-heading-title elementor-size-default\"><a href=\"\/\">Home<\/a> &nbsp; &nbsp; <a href=\"\/#about\">About Us<\/a> &nbsp; &nbsp; <a href=\"\/#service-area\">Service Area<\/a> &nbsp; &nbsp; <a href=\"\/intake-forms\/\">Intake Forms<\/a><\/h5>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4d0a4c01 elementor-align-right elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"4d0a4c01\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/care4seniors.net\/contact\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact Us<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4883a541 elementor-section-full_width elementor-section-height-min-height elementor-section-items-top elementor-section-height-default\" data-id=\"4883a541\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2769fe00\" data-id=\"2769fe00\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4d917f5d elementor-widget elementor-widget-heading\" data-id=\"4d917f5d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">New Patient Intake Forms<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-65666492 elementor-widget elementor-widget-text-editor\" data-id=\"65666492\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 13-03-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Please find the following PDF forms available for download:<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-bcd6e66 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"bcd6e66\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b48a46d\" data-id=\"b48a46d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-41c52de elementor-position-left elementor-view-default elementor-mobile-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"41c52de\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/care4seniors.net\/wp-content\/plugins\/elementor\/assets\/css\/widget-icon-box.min.css\">\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/History-form-3.pdf\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-download\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/History-form-3.pdf\" >\n\t\t\t\t\t\tMedical History Form\t\t\t\t\t<\/a>\n\t\t\t\t<\/h5>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-82a7c11\" data-id=\"82a7c11\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2dfce57 elementor-position-left elementor-view-default elementor-mobile-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"2dfce57\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/demographic-form-3.pdf\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-download\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/demographic-form-3.pdf\" >\n\t\t\t\t\t\tDemographic Form\t\t\t\t\t<\/a>\n\t\t\t\t<\/h5>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b5ddb24\" data-id=\"b5ddb24\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1be7f3b elementor-position-left elementor-view-default elementor-mobile-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"1be7f3b\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/Intake-forms-2.pdf\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-download\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/Intake-forms-2.pdf\" >\n\t\t\t\t\t\tConsent Intake Form\t\t\t\t\t<\/a>\n\t\t\t\t<\/h5>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-13cf3e1 elementor-widget elementor-widget-text-editor\" data-id=\"13cf3e1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Please also see our Privacy Practices:<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5567a5f elementor-position-left elementor-view-default elementor-mobile-position-top elementor-vertical-align-top elementor-widget elementor-widget-icon-box\" data-id=\"5567a5f\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/Notice-of-Privacy-Practices.pdf\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-download\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\t\t\t\t<h5 class=\"elementor-icon-box-title\">\n\t\t\t\t\t<a href=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/08\/Notice-of-Privacy-Practices.pdf\" >\n\t\t\t\t\t\tNotice of Privacy Practices\t\t\t\t\t<\/a>\n\t\t\t\t<\/h5>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-26374ccc elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"26374ccc\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-7f78d37f\" data-id=\"7f78d37f\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-24dba6f0 elementor-widget elementor-widget-image\" data-id=\"24dba6f0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"329\" height=\"290\" src=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/05\/specialty-senior-care-logo-cropped.png\" class=\"attachment-full size-full wp-image-24\" alt=\"\" srcset=\"https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/05\/specialty-senior-care-logo-cropped.png 329w, https:\/\/care4seniors.net\/wp-content\/uploads\/2022\/05\/specialty-senior-care-logo-cropped-300x264.png 300w\" sizes=\"(max-width: 329px) 100vw, 329px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-7d79b525 elementor-hidden-tablet elementor-hidden-mobile\" data-id=\"7d79b525\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3f461aa1 elementor-widget elementor-widget-heading\" data-id=\"3f461aa1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">All materials copyright Specialty Senior Care PLLC, all rights reserved.<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-52299f3d\" data-id=\"52299f3d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7c2f0d78 elementor-widget elementor-widget-heading\" data-id=\"7c2f0d78\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Phone: 847-538-6636<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-65d7e40c elementor-widget elementor-widget-heading\" data-id=\"65d7e40c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Fax: 888-816-0167<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7eae45e6 elementor-widget elementor-widget-heading\" data-id=\"7eae45e6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\"><a href=\"mailto:admin@care4seniors.net\">admin@care4seniors.net<\/a><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home &nbsp; &nbsp; About Us &nbsp; &nbsp; Service Area &nbsp; &nbsp; Intake Forms Contact Us New Patient Intake Forms Please find the following PDF forms available for download: Medical History Form Demographic Form Consent Intake Form Please also see our Privacy Practices: Notice of Privacy Practices All materials copyright Specialty Senior Care PLLC, all rights [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/pages\/328"}],"collection":[{"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/comments?post=328"}],"version-history":[{"count":16,"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/pages\/328\/revisions"}],"predecessor-version":[{"id":363,"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/pages\/328\/revisions\/363"}],"wp:attachment":[{"href":"https:\/\/care4seniors.net\/wp-json\/wp\/v2\/media?parent=328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}