Avera@Home Self Assessment

Are you interested in finding out which Avera@Home services are recommended for you or a loved one?

Complete the following self-assessment and one of our representatives will be in touch with you – within 24 business hours – to provide recommendations and answer questions.

* Denotes required fields

I’m interested in meeting with an Avera@Home representative to discuss home health or hospice needs for myself or a loved one.

Yes
Not at this time

I am seeking assistance/information for:

A family member
Myself

Do you or does your loved one... Select all that apply

Have safety concerns in the home such as using stairs, slipping or falling?
Feel tired in the morning or snore?
Travel and need home medical equipment to be portable?
Have tired or swollen ankles?
Have difficulty organizing and taking medications as prescribed?
Have frequent physician / medical visits?
Have a new medical diagnosis?
Have an overall decline in health?
Have a life-limiting illness, which was diagnosed by a health care provider?
See a rapid decline in your ability to care for yourself?
Have a history of frequent hospitalizations or medical needs?

Do you have any specific home health questions or concerns that you would like to talk about with an Avera@Home representative?

Please enter your information (as the person completing this form).

* First Name

* Last Name

* Phone Example: 123-123-1234 x123

* ZIP Code Example: 12345

* Email

Find Avera@Home Locations

Choose a service below to view more details and a list of locations. If you don't see a location near you, please contact us to find out if we provide services in your area.

Home health

Hospice

Home Medical Equipment

Live Better. Live Balanced. Avera.

Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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Avera@Home Self Assessment

Find Avera@Home Locations