Care Receiver Information — ElderCARE Lake County

CONTACT US TO Sign Up for ElderCARE Services

ElderCARE Lake County serves older adults in northern Lake County, Illinois, generally considered to be north of Route 60. If you or an older adult you know needs help from ElderCARE, please fill out the following form or download a full application. An ElderCARE staff member will follow up with you.

Your Name

First Name

Last Name

Your Phone Number

(###)

###

####

Your Email Address

Name of Person Needing Assistance

First Name

Last Name

Address of Person Needing Assistance

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please check which services are requested:

Friendly Visitor

Grocery Shopper

Transportation to Medical Appointments

Information or Referral for additional services

Home Safety Check

Safety Item Installation Assistance

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