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Hello.
Completing our quick intake is the first step to securing our services. Once submitted, we will review the needs and follow-up via phone with a comprehensive next step plan. Our goal is to begin services based on the desired start date; however, this can vary based on insurance coverage. We promise to provide clients and their loved ones with the best service. They will experience the difference that truly personalized, family-centered care can make. At Home Palmetto—where care is so good, you'll soon find yourself calling us family.

Quick Client Intake Form

Client Birthday
Month
Day
Year
Services Needed (select all that apply):
Insurance Information (select all that apply):
Hours Needed Per Week
Desired Start Date:
Month
Day
Year
Contact Person Submitting Form

After review we will contact you within 24 hours for additional documentation.

885 Gold Hill Rd. Suite 3014
Fort Mill, South Carolina 29708
Tel: 803-752-4722
hello@athomepalmetto.com

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Hours of Operation:

Monday-Friday | 9am - 5pm

24-hour client support

© 2025 by At Home Palmetto

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