Phone:832.612.0472
Email:info@lifefoundationhomecare.com
Hours of Operation:Monday-Friday 9:00am to 5:00pm

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VA Aid and Attendance

Aid and Attendance Interest Form
Please submit this form if you are interested in applying for VA Aid and Attendance benefits for home care services on your or someone else's behalf.
Your Name*
This is your information. If you are submitting for someone else, we will get their information below
First Last
Your Email*
Your Phone*
Are you applying for yourself or for someone else?*
- Self
- Someone else, who is a Veteran or Surviving Spouse
Your relationship with the person you are referring?
Should we follow up with you?
- Yes
- No, please contact the Veteran/Surviving Spouse
Name of the Veteran or Surviving Spouse
First Last
Veteran/Surviving Spouse Email
Veteran/Surviving Spouse Phone
Address where service needs to be provided*
Street Address Address Line 2 City State ZIP Code
Date of Birth of Veteran/Surviving Spouse
MM slash DD slash YYYY
War during which Veteran served?
- WWII
- Korean
- Vietnam
Services needed? (Select all that apply)
- Select All
- Bathing
- Dressing
- Toileting
- Walking
- Meal Prep
- Light Housekeeping
Additional Comments
Consent*
Life Foundation Home Care is not affiliated with the Department of Veteran Affairs or Veterans Home Care. Life Foundation Home Care is an independent Home Care agency providing home care to Veterans and Surviving Spouses. Submitting this form doesn't make you eligible for VA benefits.
I understand

Δ

About Us

Life Foundation Home Care is an award winning Texas based Home Care agency that provides quality and affordable in-home care in Greater Houston, Dallas-Fort Worth, Austin, San Antonio, College Station-Bryan and Beaumont-Port Arthur area including Houston, Katy, Sugar Land, Stafford, Missouri City, Bellaire, Pearland, Richmond, Rosenberg ... Read More

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12808 W Airport Blvd, Suite 260L Sugar Land, TX 77478
832.612.0472
info@lifefoundationhomecare.com

Dallas Office
15150 Preston Road Suite 300 Dallas, TX 75248
214.764.9878

San Antonio Office
7550 W IH-10 Suite 800 San Antonio, TX 78229
210.571.0120

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