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Medicare F.A.Q.

Contact Us

Comfort Living Home Health and Residential services.
Tel: (405) 735 6700.
Fax: (405) 735-6701.
Physical address: 10101 S. Pennsylvania Ave. Suite B, Oklahoma City, Oklahoma 73159.

Services request form.

Please fill out as much information as possible. This information will help us better serve you. Thank you.
Salutation:
First name:
Last name:
Email:
Primary phone number: e.g 4051234567
Secondary phone number: e.g 4051234567
Physical address:
City:
State:
Zip code:
Security code: 323988
Which choice below best describes your need?
Senior care residence.
Home Services and/or Products.
Both senior care residence and In-Home options.
Medical Equipment and/or Eldercare Products.
Advisory and/or Consultative Services.
Business / Employment.
Where will these service(s) and/or product(s) be provided?
In-Home.
Adult Day Care Facility.
Independent Living / Senior Community.
Independent Living / Senior Community.
Assisted Living Facility.
Continuing Care Retirement Community.
Skilled Nursing Facility / Nursing Home.
Please provide the desired location for the service(s) or product(s) to be provided:
City:       Zip code:
Which choice below best describes your need?
Adult Day Care / Respite Care. Hospice Services.
Personal Care (e.g. Bathing, Toileting or Grooming). Insurance Services.
Companion Services. Live In Home Care.
Visiting Physician / House Calls. Meal Preparation.
Geriatric Assessment / Evaluation Rehabilitation Services (e.g. Physical Therapy).
Home / Safety Monitoring. Transition Services (e.g. Home Selling & Buying).
Home Healthcare (Medical). Transportation Non-Medical (e.g. Errands, Shopping).
Homemaker / Household Services. Transportation Medical (Non-Emergency).
Homecare (Non-Medical). Visiting / Private Duty Nursing.
Does the care recipient need price quotes and/or more information on any of following?
(Please select all that apply)
Ambulatory Aids (e.g., Walkers, Canes, Manual Wheelchairs). Long Term Care Insurance.
Other Insurance. Memory Aids.
Powered Wheelchairs & Scooters. Hearing Aids.
Durable Medical Equipment. Medication Compliance.
Home Medical Supplies. Oxygen.
Medical Alarms / Personal Help Buttons / Emergency Response. Prescription Services.
Senior Product Discount Programs. Nebulizer Treatment.
Diabetic Supply. Health Insurance (e.g. Medicare, HMO, PPO, or Medigap plans).
Vision Enhancement Products. Incontinence Supplies.
Does the care recipient need price quotes and/or more information on any of following?
(Please select all that apply)
Private pay. Medicaid / Public Assistance .
Medicare. Long Term Care Insurance.
Combination (Private Pay & Medicare).
How much have you budgeted for these "out-of-pocket" expenses?
(please select one).
Less than $250 per week. $1,000 to $1,500 per week.
$250 to $500 per week. $500 to $1,000 per week.
Over $1,500 per week.