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 HomeCare & Hospice Services has developed this short questionnaire to help determine what may be the right choice. How often does the patient need medical care?*ContinuousNo more than a few hours a dayIs the patient's condition life-limiting?*YesNoIs the patient's condition life-limiting?*YesNoIs the patient homebound? (needs assistance in walking or leaving their home)*YesNoDoes the patient prefer to stay in their own home?*YesNoWould the patient prefer living in a social setting with others of similar ages and backgrounds?*YesNoDoes the patient have a new medical condition, exacerbation of a previous medical condition, recent fall or recent surgery?*YesNoWould the patient benefit from additional medical equipment or home infusion treatment?*YesNoWould the patient benefit from services such as physical therapy, speech therapy, or occupational therapy?*YesNo / Not SureWould the patient benefit from additional home medical equipment or home infusion treatment?*YesNoWould the patient benefit from telemonitoring, advanced wound care, or other similar treatments?*YesNo / Not SureWould the patient benefit from additional home medical equipment or home infusion treatment?*YesNoWould the patient benefit from additional home medical equipment or home infusion treatment?*YesNo / Not Sure* = This is a required field Before we proceed, tell us a little about yourself.I’m interested in care for:*Family MemberFriendMyselfOtherI’m seeking care in:*North CarolinaSouth CarolinaVirginiaOtherI’m seeking care in zip code:*Name* First Last Email Phone*Name of Person Requiring Care* First Last Please let us know how we can help:* = This is a required field