Inclusive Home Care Services

 

Nursing Service Enquiry Form

Please submit your requirements and we will get back to you shortly.

    Your Details

    Your Name

    Contact number

    Email ID

    Patient Details

    Name

    Age

    Sex

    Weight

    Can Stand

    Bed Ridden

    Walk for 10 steps

    Feeding

    Tracheostomy

    Uses Bipap/Cpap/Ventilator

    If yes

    Additional information / Brief condition of the patient

    Nurse Requirement

    We need

    Time

    Type of Catagory

    Select Category

    A Category - NURSE QUALIFIED

    B Category - Just an Attender

    Date and time by when you want

    Duration

    Language preference ( subject to availability)

    Terms and Conditions

    • One time registration of Rs 1000 to be made on confirmation and is valid for 1 year.

    • Payment to be made every month in advance.

    • Replacement - In case there is a need for replacement. Subject to availability only.

    • Code of Conduct- You shall ensure safety of the nurse deployed for all types of abuses. Any complaint about such abuse by the nurse shall be considered seriously.

    • Most of the nurses we provide are verified by police. In case there is any issue with the nurse, you shall immediately inform the concerned INCLUSIVE IN INDIA APPOINTED supervisor. Late complaints shall not be entertained. We shall discuss, assess the situation and shall take appropriate action.

    • You shall not deal anything directly with the nurse including any monetary transaction. Company shall not be responsible for such direct transactions.