Schedule a Carefarm Visit

Sun	Mon	Tue	Wed	Thu	Fri	Sat
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30
31

Selah Carefarm Informed Consent and Waiver - Virtual Grief Counseling

We are so deeply sorry you need us. We are so deeply thankful you’ve found us. We will do all we can to help you remember your beloved in ways that are profound, even if infused with grief.

The MISS Foundation, established in 1996 by Dr. Joanne Cacciatore, is an international 501(c)3, volunteer-based organization providing C.A.R.E. [counseling, advocacy, research, and education] services to families experiencing the death of a child and to other people who are suffering the traumatic loss of a loved one.

Values

We recognize that the death of a child at any age is one of life’s most tragic experiences;
We honor the sacredness of every member of the family;
We value integrity, kindness, and respect in all we do;
We provide mindful, compassionate and respectful care of others and ourselves;
We embrace the commitment of lifelong care in the aftermath of a child’s death;
We foster a healing environment in which individuals, families and communities may, when ready, experience a sense of hope for the future;
We recognize the potential in human beings to help others;
We promote a community-based approach to grief including rescue animals, eco therapies through retreats and activities in nature, and mindfulness practices.

We are so deeply sorry you need us. We will do all we can to help you in ways that are profound, even if infused with grief.

Clients only: Informed Consent

We are an international nonprofit founded in 1996. We provide guidance, support, and counseling around traumatic grief for tens of thousands of grieving families every year. We help adults and children learn to cope with their painful emotions and trauma in a way that no other nonprofit does. We do not medicalize grief. We recognize grief as a normal reaction to an abnormal tragedy. We help clients find their personal and family strengths and we help them learn to bear the unbearable in a way that promotes open, healthy coping, and integration. At times, grieving clients may be better served by another agency or clinician. In this rare instance, we will provide references to another provider in order that you may receive appropriate services.

Donations. The hourly rate at the Selah Carefarm ranges depending on the counselor and your income. There is a sliding scale cash fee available for clients. The minimum donation for Carefarm counseling with one of our trained providers is $45 per hour. Our scale works like this: take the first two to three digits of your household income. If you make $45K or less per year, you will donate $45 per hour; $50K per year, $50 per hour; $100K per year, $100 per hour, etc. It’s often less than many insurance co-payments. This ensures that even very low-income families can have access to care while also allowing us to maintain our animals and Carefarm. All donations raised from counseling go directly into the Carefarm program to help us help other families and care for our rescued animals. On the honor system, we ask you to donate according to your annual income, honestly. What you contribute is a tax-deductible donation.

Virtual Grief Counseling. Virtual Grief Counseling (VGC) refers to providing counseling services remotely using telecommunications technologies, such as video conferencing or telephone. Although there are benefits of virtual grief counseling, there are some differences between in person counseling and virtual grief counseling, as well as some risks. For example:

Risks to confidentiality. Because VGC sessions take place outside of the counselor’s private office, there is potential for other people to overhear sessions if you are not in a private place during the session. On our end I will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for your session where you will not be interrupted.
Issues related to technology. There are many ways that technology issues might impact telepsychology. For example, technology may stop working during a session or may have disruptions due to internet issues. In that case you and your counselor will decide together how to proceed and reschedule your session.
Crisis management and intervention. In your first online session with your counselor, you will agree on what to do in case of crisis or emergency. Your calls will be returned within 24 hours except on holidays or during your counselors’ absence. If you cannot wait for us to return your call, contact your family physician or the nearest emergency room.

Deposits are non-refundable. We are a small nonprofit and depend entirely on donations to our organization. From the time you register, your time slot is reserved for you and cannot be scheduled by any other client. Before, during and after your session we accommodate you the best we can with personal phone calls, intake and support. Unfortunately, there is a very high demand for our services. We are unable to accept cancellations within two days of your scheduled session.

Appointments. Regular attendance at your scheduled appointments, on time, is important. Appointment availability varies with the client load at the time. High demand appointments (off hours, late afternoons, Sundays) are likely to be sporadic in their availability.

Privacy, confidentiality, and records. We do not bill insurance companies because we will not assign a grieving client a psychiatric diagnosis of mental illness. Thus, the only records we will keep are your intake forms. We still respect federal guidelines around confidentiality in communications and any written documents. However, there are some exceptions to confidentiality defined in the state and federal statutes. The most common of these exceptions are when there is a real or potential life or death emergency, when the court issues a subpoena, or when child/elder/animal abuse or neglect is involved. We also may participate in a process where selected cases are discussed with other professional colleagues to facilitate continued professional growth and to get you the benefit of a variety of professional experts. Most often counselors here will turn to one of the Carefarm supervisors, Dr. Joanne Cacciatore or Paul Kahn, LCSW.

Purpose, limitations, and risks of supportive counseling. Counseling, like most endeavors in the helping professions, is not an exact science. While the ultimate purpose of counseling is to help you learn to cope with the effects of traumatic grief, there are no guarantees that any counseling provided will be useful. Moreover, the process of counseling usually involves working through painful memories and other issues that can result in some emotional or psychological pain. Counseling may result in decisions about changing behaviors, employment, substance use, schooling, housing, relationships, or virtually any other aspect of your life. In the case of marriage and family counseling, interpersonal conflict can increase as we discuss family issues.

Counseling process and rights. Your counseling will begin with one or more sessions devoted to an initial assessment in order to ascertain your unique tragedy and trauma, grief, social milieu, and emotions around your very deep loss. We may also want to get to know your background, your childhood and family system issues, and any other factors that may be relevant. You also have the right to guide all aspects of care, on or off the Carefarm, or to withdraw from our program.

Our relationship. The client/counselor relationship is unique in that it is exclusively for the benefit of clients. If there is ever a time when you believe that you have been treated unfairly or disrespectfully, please talk with us about it. You can also contact Carefarm supervisors at info@missfoundation.org. We all care very deeply about you. We want to address any issues that might get in the way of the counseling as soon as possible.

Consent for counseling. Consent is hereby given for VGC. At this time we are not providing VGC for minors.

We are so deeply sorry you need us. We are so deeply thankful you’ve found us. We will do all we can to help you remember your beloved in ways that are profound, even if infused with grief.

Selah Carefarm Informed Consent and Waiver

We are so deeply sorry you need us. We are so deeply thankful you’ve found us. We will do all we can to help you remember your beloved in ways that are profound, even if infused with grief.

The Selah Carefarm is a respite for those with a shattered heart. We are a restorative space and therapeutic community based in a practice of caring for humans who have known the most painful losses, healthy coping and integration of traumatic grief, and compassion/ahimsa: nonviolence and compassion for all. We will do everything we can to be sure that you feel held and safe here. We hope you experience both receiving and giving of caring and compassion. We hope you feel able to remember and feel your precious loved one …

We are a rural carefarm so you should expect to get hairy, dirty, and slobbery if you want to interact with the animals. We house 30 or more animals rescued from varying levels of torture, abuse, and neglect. Please make a minimum donation of $25 per hour for visits that do not including counseling services. We welcome between 20-40 clients and visitors a week from around the world. As such, we have some guidelines for humans who come to our sacred home. During your stay here, we ask that you:

Please wear closed toed, flat shoes and bring water, sunscreen if you use it, and vegan snacks.
If you would like to leave something to honor your beloved at The Quiet Place in memory of your child/brother/sister/grandchild/partner/parent/person, please bring it. You may also bring a 10-15 inch, or longer, piece of material (cloth like a shirt, pillowcase, sock) to tie on our Remembrance Tree.
If you want to bring the animals some snacks, you may bring mini carrots or cut up carrots (2-3” long).
Please do not smoke anywhere on our ten acres. Its not healthy for the animals or the earth or for you!
For your own, and others’ safety, please do not use alcohol, drugs, or any substance on the carefarm that alters cognition. Please do not visit the carefarm if you are under the influence of any substance.
Please treat our animals with the utmost love, compassion, and respect. Our animals are equal partners in our model of care. They all have a traumatic and painful history. If they choose to spend time with you and you feel the same, we welcome that beautifully and magical exchange. Please do not chase, pursue, or correct any animal at any time.
Do not enter the horse area without a counselor or volunteer guide.
Please clean up after yourself. Please pick up trash, return any items to their original places, and tidy up any area where you were spending time.
We invite you to pay attention to nature. In so doing, know we have many insects including ants, ladybugs, and beetles. Please try to pay attention when you are walking, working, or playing so as not to harm or disrupt them.
Please be sure all gates are securely closed. Check and double-check them. Leaving a gate open could cost an animal’s life, and we love our animals.
Please respect other clients who might be here at the same time. This is a place to ‘be’ so please be aware of allowing space for others in deep feeling/processing.
We are a vegan carefarm. We promote mindful, healthy eating based in compassionate ethics. As such, please bring only fruits, vegetables, grains, beans, seeds, nuts, and other healthy choices. To drink, we welcome teas, juices, coffee, and water.
We invite you to feel and remember. We welcome your participation in our Memorial Tree, Holy Tree, lighting incense in The Quiet Place, and other special remembrance rituals. One of our carefarm helpers can provide direction before your departure.
We are on Oak Creek so bring water shoes if you want to spend time at the river. We also have kayaks here that you can use if you have experience kayaking (please be aware of risks involved).
Please contact us if you have more questions at info@missfoundation.org.
There are no bathroom facilities here yet but there is a port-o-potty. Park at the top of the property, in the roundabout, and someone will meet you at the “Welcome” bench near the pond. Again, please arrive on time.
Please do not bring your pets to the Carefarm for the safety of our animals and yours.
Please note: No children under 7 years old are allowed due to safety concerns. The Selah Carefarm is a therapeutic space for those experiencing traumatic grief. We welcome families from all socioeconomic classes, all and no religions, all regions around the world, and all ethnic backgrounds. However, we have many open waterways that are unfenced and our animals roam freely; thus, this is not a safe environment for children under the age of 7. Please be sure that all guests who register meet this minimum safety age.

We are so deeply sorry you need us. We will do all we can to help you in ways that are profound, even if infused with grief.

For them,

The MISS Foundation Selah Carefarm Team

Waiver and Release From Liability

Selah House Carefarm, a program of the MISS Foundation and Dr. Joanne Cacciatore, provides a unique opportunity for education, support, counseling, and community. Depending on the activity or program, individuals and groups will be able to learn about and have direct contact with live animals that may include but are not limited to: animals such as horses, peacocks, goats, sheep, dogs, and other animals that may not be listed.

Waiver and Release from Liability for Care Farm

I, (adult or minor child) HEREBY WAIVE AND RELEASE, indemnify, hold harmless and forever discharge property owners Dr. Joanne Cacciatore and Dave Decker, and the MISS Foundation, its agents, employees, officers, directors, affiliates, volunteers, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether know or unknown, in law or equity, that I or Minor Child ever had or may have arising from or in any way related to my and/or my child’s participation in any events or activities conducted by, on the premises of, or for the benefit of, the property owners and the MISS Foundation, provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful misconduct.

I understand that the activities that I and /or children will participate in and that I/children will see are inherently dangerous and may cause serious or grievous injuries, including bodily injury, damage to personal property and/or death. I/children will be in direct contact with animals that include but are not limited to: goats, rabbits, horses, chickens, dogs, peacocks, pigs., among other animals that may not be listed.

I understand that, as with most animals, they may react in an unpredictable way to sounds, sudden movements, people, or other animals that could result in injuries to people. On behalf of myself, said children, my heirs, assigns and next of kin, I/children waive all claims for damages, injuries and death sustained to me/children or property, that I/children may have against the aforementioned released party to such activity.

By this waiver, I/children, assume any risk, and take full responsibility and waive any claims of personal injury or death or damage to personal property with the property owners and the MISS Foundation including but not limited to visiting the farm, wading, swimming or entering Oak Creek, observing or interacting with the animals, using the facility and its equipment in any manner, form or fashion, and practicing and/or engaging in other related activities including the initiating of prohibited contact with the animals on and off the premises and disobeying any Carefarm regulations both posted and unposted. It is a condition of entry that visitors observe all warning signs, do not venture over safety barriers and do not enter the Carefarm’s off limit areas.

This WAIVER AND RELEASE contains the entire agreement between parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this WAIVER AND RELEASE. The provisions of the WAIVER AND RELEASE may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties. The provision of this WAIVER AND RELEASE will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of the property owners and the MISS Foundation, whether by agreement, by operation of law, or otherwise.

I have read, understand and fully agree to the terms of this WAIVER AND RELEASE. I understand and confirm that by signing this WAIVER AND RELEASE that I/children have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress of threat of duress, without inducement, promise or guarantee being communicated to me. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 year of age or older, and/or legal guardian of children, and mentally competent to enter into this waiver.

I understand that this agreement contains a promise not to sue the property owners, the MISS Foundation or their employees, board members or volunteers.

About Our Counseling Program
Informed Consent

Background and Services.

We are an international nonprofit that has been around since 1996. We provide guidance, support, and counseling around traumatic grief for tens of thousands of grieving families every year. We help adults and children learn to cope with their painful emotions and trauma in a way that no other nonprofit does. We do not medicalize grief. We recognize grief as a normal reaction to an abnormal tragedy. We help clients find their personal and family strengths and we help them learn to bear the unbearable in a way that promotes open, healthy coping, and integration.

At times, grieving clients may be better served by another agency or clinician. In this rare instance, we will provide references to another provider in order that you may receive appropriate services.

Donations. The hourly rate at the Selah Carefarm ranges depending on the counselor and your income. There is a sliding scale cash fee available for low-income clients. The minimum donation for Carefarm counseling with one of our trained providers is $35 per hour up to $35,000 per year income and the first two numbers of annual income above that (i.e. if you make $40K per year, $40 per hour; $60K per year, $60 per hour, $100K per year, $100 per hour, often less than many insurance co-payments. This ensures that even very low-income families can have access to care while also allowing us to maintain our animals and carefarm. Appointments with Dr. Joanne Cacciatore may be difficult to secure and her fees range from $100 per hour to $225 per hour depending on ability to pay and availability. All donations raised from counseling go directly into the Carefarm program to help us help other families and care for our rescued animals.

On the honor system, we ask you to donate according to your annual income, honestly. What you contribute is a tax-deductible donation.

Appointments. Regular attendance at your scheduled appointments, on time, is important. Deposits are non-refundable. Appointment availability varies with the client load at the time.

Cancelation policy. Please note, we do not offer refunds for canceled appointments. If you are not able to make your scheduled appointment, we will try to reschedule your appointment within the next 12 months, based on the availability of our counselors. From the time you register, your time slot is reserved for you and cannot be scheduled by any other client. We provide trained staff on site during your visit. Before, during and after your visit we accommodate you through our best efforts with personal phone calls, intake and support. Unfortunately, there is a very high demand for our services. In case of cancelation we therefore cannot return funds, except if your visit had to be canceled by us. We can reschedule your visit within the next 12 months. Please contact us at info@missfoundation.org if you need to reschedule.

Privacy, confidentiality, and records. We do not bill insurance companies because we will never give a grieving client a psychiatric diagnosis of mental illness. Thus, the only records we will keep are your intake forms. Ordinarily, we still respect federal guidelines around confidentiality in communications and any written documents. However, there are some exceptions to confidentiality defined in the state and federal statues. The most common of these exceptions are when there is a real or potential life or death emergency, when the court issues a subpoena, or when child/elder abuse or neglect is involved. We also may participate in a process where selected cases are discussed with other professional colleagues to facilitate continued professional growth and to get you the benefit of a variety of professional experts. Most often counselors here will turn to one of the carefarm supervisors, Dr. Joanne Cacciatore or Paul Kahn, LCSW.

Purpose, limitations, and risks of supportive counseling. Counseling, like most endeavors in the helping professions, is not an exact science. While the ultimate purpose of counseling is help you learn to cope with the effects of traumatic grief, there are no guarantees that any counseling provided will be useful. Moreover, the process of counseling usually involves working through painful memories and other issues that can result in some emotional or psychological pain. Counseling may result in decisions about changing behaviors, employment, substance use, schooling, housing, relationships, or virtually any other aspect of your life. In the case of marriage and family counseling, interpersonal conflict can increase as we discuss family issues.

Counseling process and rights. Your counseling will begin with one or more sessions devoted to an initial assessment in order to ascertain your unique tragedy and trauma, grief, social milieu, and emotions around your very deep loss. We may also want to get to know your background, your childhood and family system issues, and any other factors that may be relevant. You also have the right to guide all aspects of care, on or off the carefarm, or to withdraw from our program.

Our relationship. The client/counselor relationship is unique in that it is exclusively for the benefit of clients. If there is ever a time when you believe that you have been treated unfairly or disrespectfully, please talk with us about it. You can also contact carefarm supervisors at info@missfoundation.org. We all care very deeply about you.

It is never our intent to cause misunderstandings that may inadvertently result in hurt feelings. We want to address any issues that might get in the way of the counseling as soon as possible. This includes administrative or financial issues as well.

Consent for counseling. Consent is hereby given for counseling on the carefarm. In the case of a minor child, I hereby affirm that I am a custodial parent or legal guardian of the child and that I authorize services for the child under the terms of this agreement.

We are so deeply sorry you need us. We are so deeply thankful you’ve found us. We will do all we can to help you remember your beloved in ways that are profound, even if infused with grief.

Daniel John Coleman Memorial Fund

A family who recently lost their beloved son, brother and nephew, in the most difficult days after his death, found the Carefarm. In gratitude for the compassion and kindness they experienced, they created this dedicated fund in memory of Daniel, and have pledged a $75,000 matching donation from the Daniel John Coleman Memorial Fund to help build a family home for those experiencing the enormity of grief.

Your tax deductible donation will be matched dollar-for-dollar up to $75,000 until December 31, 2018. Our goal is to raise $150,000 in addition to the nearly $150,000 raised to date. When we reach our goal of $300,000, construction of Selah Family House will begin!

Frequently Asked Questions about Selah House

Q: What is the Selah House and Carefarm?
A: This is a place where families can go to give and receive connection, compassion and understanding. All the animals on the carefarm have been rescued from abuse, neglect and torture. Our grieving families know what it means to suffer, and so do these animals. In addition, we teach mediation, yoga, bibliotherapy, and will soon have a family house where families can come and stay on site.

Q: How can I help?
A: We need donations to build the family house on the carefarm. We need your help on the carefarm. We need in-kind donations like supplies, landscape materials, tools, animal feed and tack. If you have something to donate or if you’d like to help on the carefarm please contact us at info@missfoundation.org. Read Yahoo’s feature story about the Selah Carefarm here.

Q: When do you expect the family house to be completed?
A: That depends on the success of this fundraising campaign. Our contractor estimates 9 months once we begin construction.

Q: How can I reserve a place and time to come to the Selah Family House?
A: Please check back here. As we get closer to completion, we will have an inquiry form posted. You can also follow our MISS Foundation Facebook page.

Q: Can I visit the carefarm?
A: Carefarm visits are by appointment only. We are not open to the public but we do have work days. If you would like to attend and volunteer at a work day, follow our Selah Carefarm Page here where we will announce upcoming events. We are also on Instagram at Selah_Carefarm!

Q: How will my funds be used?
A: All funds will be used toward the construction of the family house unless designated otherwise.

Q: Is care farming based on any science?
A: Yes! Carefarming, as a whole and in its individual components, has been shown to help many vulnerable population groups. Many countries in Europe utilize care farming as a humanistic approach to human suffering in vulnerable groups with tremendous outcomes that reduce harm and help people improve coping. And, care farming costs a fraction of treatment as usual. The average day at a carefarm costs between $60-$150. The cost of treatment as usual in an inpatient setting is about $1000- $1100 a day. Learn more about the scholarly literature here.

Q: What is the meaning of Selah?
A: The Selah House is named after the Hebrew word selah and after the Selah Grief Model (Cacciatore, 2011), a mindfulness-based framework that recognizes two foci: self and other, the intrapersonal and the interpersonal, in addition to the space between two beings. Selah derives from the Hebrew word celah, often noted in the book of Psalms meaning 1) pause, stay with what you’ve just experienced; 2) reflect, feel deeply what you’ve just experienced; and 3) find meaning, allowing it to unfold in its time without rushing to the next passage.

Q: What if I or my business wants to make a very large contribution? Are there naming opportunities?
A: For donations of $5,000 or more, please contact MISS Foundation Executive Director Kelli Montgomery, 512-922-3104, kelli.montgomery@missfoundation.org for special dedication requests.

Q: How will the Selah Family House work?
A: Currently, traumatically bereaved people, most often parents, grandparents, and children, come from around the world to work with Dr. Cacciatore. Right now, our facilities can only hold one family at a time, and suffering families in the local area and also from around the world, must wait until the space opens before they can come to get help. There is often a 6-9 month waiting list. When the family house is completed, Dr. Cacciatore and our team will be able to serve more grieving people. In addition, the carefarm will incorporate more rescue animals, a therapeutic farm-to-table program, and other health enhancing activities that an agrarian environment allows.

Q: Though you have a clear, twenty year history of helping people endure traumatic grief, with your current plans, how will you know if the carefarm is helping people in the long term?
A: This is an excellent question. We are fortunate to have already begun to build our core research team with some of the top scholars in their field, including Dr. Joanne Cacciatore, Dr. Rich Gorman, Dr. Jen Huberty, Kara Thieleman and Dr. Trish Wonch-Hill.

This means that we will collect data and longitudinally interview those who have been through our programs. We will be publishing those data in order to encourage more NGOs and agencies seeking to help others learn about care farming. We are also advancing a training program for providers who may want to begin their own carefarm in their communities.

Q: Is the Selah House green and sustainable?
A: Yes. We commit to environmental health, social and economic equity, animal welfare, and overall consciousness raising in our therapeutic community.

Q: What model or framework is going to guide the Selah House?
A: The model (Cacciatore & Gorman, 2016) is based on current carefarming practices, research in therapeutic spaces, and 20 years of experience working with traumatized people from around the world.

Frequently Asked Questions about Selah House

Q: How can I help?
A: We need donations to build the respite center on the carefarm. We need your help on the carefarm. We need in-kind donations like supplies, landscape materials, tools, animal feed and tack. If you have something to donate or if you’d like to help on the carefarm please contact us at info@missfoundation.org. Read Yahoo’s feature story about the Selah Carefarm here.

Q: When do you expect the respite center to be completed?
A: That depends on the success of this fundraising campaign. Our contractor estimates 9 months once we begin construction.

Q: How can I reserve a place and time to come to the Selah House?
A: Please check back here. As we get closer to completion, we will have an inquiry form posted. You can also follow our MISS Foundation Facebook page.

Q: How will my funds be used?
A: All funds will be used toward the construction of the respite center unless designated otherwise.

Q: Is care farming based on any science?
A: Yes! Care farming, as a whole and in its individual components, has been shown to help many vulnerable population groups. Many countries in Europe utilize care farming as a humanistic approach to human suffering in vulnerable groups with tremendous outcomes that reduce harm and help people improve coping. And, care farming costs a fraction of treatment as usual. The average day at a carefarm costs between $60-$150. The cost of treatment as usual in an inpatient setting is about $1000- $1100 a day. Learn more about the scholarly literature here.

Q: What if I or my business wants to make a very large contribution? Are there naming opportunities?
A: For donations of $5,000 or more, please contact MISS Foundation Executive Director Kelli Montgomery, 512-922-3104, kelli.montgomery@missfoundation.org for special dedication requests.

Q: Can I visit the carefarm?
A: Carefarm visits are by appointment only. We are not open to the public but we do have work days. If you would like to attend and volunteer at a work day, follow our Selah Carefarm Page here where we will announce upcoming events. We are also on Instagram at Selah_Carefarm!

Q: What is the Selah House Carefarm?
A: This is a place where families can go to give and receive connection, compassion and understanding. All the animals on the carefarm have been rescued from abuse, neglect and torture. Our grieving families know what it means to suffer, and so do these animals. In addition, we teach mediation, yoga, bibliotherapy, and will soon have a respite center where families can come and stay on site.

Connect With Us!

Sign up for our eNews and get the latest info right in your inbox!

After you click the “Subscribe” button above, this form will close for security purposes, and we’ll send you a quick confirmation email to the address you provided. Just click the “confirm” button in that email, and we’ll add you right to our list. Thanks!

Schedule a Carefarm Visit

Your Information

Emergency Contact Information

Other Information

Additional Client 1 Information

Other Information - Additional Client 1

Additional Client 2 Information

Other Information - Additional Client 2

Additional Client 3 Information

Other Information - Additional Client 3

Beloved's Information

Schedule Your Carefarm Visit

January 2021

Additional Guests Information

Household Income Information