COVID-19 Questionnaire

Help Us with a Short Survey!

By filling out this survey, you will help us get you the care that you need. Please fill it out truthfully as it will help protect our staff, caregivers, and clients.

All fields are required unless stated otherwise.

If you would like a printable version of this form, click this link.

Additional Assistance

COVID-19 UPDATE Following New York state law, face masks are required for in-office visits. Please consider phone calls, email, or chat options for non-emergencies. We’re always here to help!

If you experience any errors submitting your form, feel free to contact us by phone. Our main office line is 716-288-9300, or drop in for an in-office meeting.

America Homecare’s main office is located at 1775 Wehrle Drive (Suite 150) Williamsville, NY 14221.

COVID-19 Questionnaire | America Homecare Inc

Help Us with a Short Survey!

Additional Assistance

**COVID-19 UPDATE** Following New York state law, face masks are required for in-office visits. Please consider phone calls, email, or chat options for non-emergencies. We’re always here to help!

COVID-19 UPDATE Following New York state law, face masks are required for in-office visits. Please consider phone calls, email, or chat options for non-emergencies. We’re always here to help!