Request Care

Submit a Care Request

Complete the form below to submit your care request. One of our Care Managers will contact you within 24 hours to review your needs.

What type of care are you looking for?*

Select all that apply

Personal CareBathing, Dressing, Grooming

Nursing SupportWound Care, Medication, Foot Care

CompanionshipOutings, Activities, Social Support

HomemakingLaundry, Meal Prep, Housekeeping

ErrandsGrocery Shopping, Appointments

Medication ManagementMedication Administration & Reminders

OtherSomething else not listed here

Any specific services you need?

Optional — select any specific clinical or support services

Collaborative CareCollaborative plans tailored to your needs and goals, created with you, your family, and healthcare providers.

Holistic AssessmentComprehensive evaluation of your physical, emotional, and social well-being to guide personalized care.

Health MonitoringRegular checks of vital signs and conditions to detect changes early and support long-term health.

Continence CareAssistance with bladder and bowel management, promoting skin health and overall comfort.

Ostomy CareSupport and guidance for ostomy management to maintain comfort, hygiene, and confidence.

Palliative CareCompassionate care focused on comfort, symptom management, and quality of life for serious illnesses.

Infusion TherapySafe and professional IV therapy at home, including medications, hydration, and nutrition.

Medication AdministrationSafe and timely delivery of prescribed medications, with careful monitoring for effectiveness and side effects.

Wound CareExpert care for surgical, chronic, or pressure wounds to promote healing and prevent infection.

Are you referring through a program?

Optional — select if this referral is funded through one of these programs

Blue Cross VIP (Veterans)Care covered through the Veterans Independence Program (VIP)

MVA / Auto InsuranceMotor Vehicle Accident referral — Form 1 Care Schedules, OCF-18/21 Billing, HCAI-Authorized

Legal Team ReferralPersonal injury law firm or paralegal referral — Form 1, tort-claim ready

Who needs care?

Name of Person Needing Care (required)

Your Name (Requester) (required)

Email (required)

Phone (US/CA: +1 only) (required)

How much care is needed?*

Select your general schedule preference (select all that apply)

Overnight

Flexible

Is care required within 48 hours?

Yes, urgent (within 48 hours)

No, not urgent

What else should our care team know?

Additional Details (required)

Attach Relevant Files

Upload any relevant documents (Form 1, PCA Form, Contact Sheet, etc.)

I hereby agree to the SJTN Care Terms & Conditions and consent to receive all services provided by the organization.

(required)

Other Ways to Reach Us

Prefer to Call?

Speak directly with our care team:

+1 (613) 770 3871 +1 (613) 870 0843

Service Package Calculator

Our Care Package Calculator can help you better understand what your care payment(s) might look like. Select the services you need below to instantly see your estimated total cost. Need help? Try

Frequently Asked Questions

Answers to common questions about SJTN Care's home healthcare services, billing, insurance coverage, caregiver qualifications, and service areas.

Submit a Care Request

Other Ways to Reach Us

Prefer to Call?

Service Package Calculator

Frequently Asked Questions

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