Now welcoming care inquiries in Danville and approved areas of Pittsylvania County. Call (434) 423-6998

Client and family application

Tell us how we may help.

Submit a short, non-medical pre-intake application. Premier will review it and contact you to arrange a free care consultation. Submitting this form does not confirm an appointment or the start of services.

Simple Private-Pay Home Care

Premier Home Care currently welcomes private-pay clients. Tell us about your loved one’s needs and preferred schedule below. We will contact you to discuss care options, pricing, and a personalized care plan.

Tell Us About Your Care Needs

Share a few details so we can discuss the right support for your family. It is okay if you are still exploring options.

Fields marked with an asterisk are required.

Looking for work? Use Our Caregiver Application

What type of assistance is needed? *

Choose all that apply, or select “Not sure yet.”

This helps us discuss options; it does not confirm a schedule.
Office hours: Monday–Friday, 9 a.m.–2 p.m.
Protect your information. Do not enter Social Security numbers, medical records, diagnoses, insurance or Medicaid numbers, banking details, background reports, or credential numbers.
Or call (434) 423-6998