We’re Here to Help

Mercy Care serves the whole community.

Our direct services to elders are provided free of charge and are kindly given by our generous volunteers to any elder in need within our capacity. There are no income or health guideline requirements for our services.

If you or someone you know would like to request a Mercy Care Friendship Volunteer, Caregiver Friend, Spiritual Care Companion, or Parish Nurse to visit, complete the form below or contact Mercy Care’s Director of Elder Care and Volunteer Services, Katherine Rhodes at krhodes@adkmercy.org or 518-523-5585.

Date of referral *

Referrer’s Contact Information

First Name

Last Name

Phone

E-Mail

Relationship to prospective elder or affiliation

Organization

Prospective Elder Information

Birthdate *

First Name *

Last Name *

Home Phone

Cellphone

Internet Access?

Internet Savvy?

E-Mail

Physical Address

County

Helpful driving directions

Covid-19 Vaccinated?

Boosted?

Enrolled in Medicaid?

Activities/assistance sought (check all that apply)

Friendly Visits or Outings

Phone Calls

Caregiver Respite/Support

Meal Preparation/Light Housekeeping

Health Counseling

Errands/Non-Medical Transportation

Medical Transportation

Spiritual Care/Support

Other

Is the prospective elder aware of and consented to this referral? *

How did you hear about Mercy Care for the Adirondacks?

Additional Notes

We’re Here to Help

Referrer’s Contact Information

Prospective Elder Information

Activities/assistance sought (check all that apply)

Resource Links

Partners