Competitor Agency Form

Step 1 of 6

Agency Information

Contact Details

Agency Name *

Phone *

Website

Date Called *

Person Spoke To *

Their Title

Step 2 of 6

Services Provided

Services Offered

Companion Care

Personal Care

Dementia / Alzheimer's Care

Respite Care

Transportation

Live-In Care

Virtual / Remote Care

License Type / Notes

General Information

How quickly can services begin?

Initial assessment or consultation?

Step 3 of 6

Pricing & Rates

Hourly Rates

Companion Care Rate

Include any tiered pricing or shift-length conditions.

Personal Care Rate

Different rate for Alzheimer's / Dementia care?

Shift Requirements & Adjustments

Minimum shift requirement

4

hours

Rates change for shorter shifts?

Rates change for longer shifts?

Overnight care rate

Live-In, Premiums & Fees

Live-in care offered?

Weekend premium?

Holiday premium?

Transportation / mileage charges

Minimum hours per week

Step 4 of 6

Payment & Caregiver Info

Payment & Insurance

Accepts Long-Term Care Insurance (LTCI)?

Works with VA benefits?

Payment model

Discounts or promotions offered?

Caregiver Information

Caregivers are…

Bonded and insured?

Caregivers background screened?

Can clients interview caregivers before services begin?

Step 5 of 6

Client Experience

Service Quality

What makes this agency different from other providers?

How are caregivers matched with clients?

How do they handle caregiver call-offs?

Someone available after hours?

Supervisory visits conducted?

Step 6 of 6

Caller Observations

Call Experience

Rings before the call was answered

1

Answered by a live person?

Did they sound friendly?

Did they ask questions about the client's needs?

Did they attempt to schedule an assessment?

Did they ask for contact information?

Overall Assessment

Overall Impression (1 – 5)

Impression notes

Additional Notes

Research Submitted

Competitor profile saved and ready for GHL upload.

Agency Name