CooloCare — Enrollment & Consent

👤 Your Information

The person managing this enrollment

First Name *

Last Name *

Email *

Phone *

❤️ Your Loved One

The person who will receive calls & texts

First Name *

Last Name *

Their Phone Number *

Your Relationship *

📦 Choose a Plan

Select the plan that works best for your family

SILVER

Companion Plan

$99/mo
First 30 days FREE

$990/year $1,188 save $198

Text messages only • Monday – Friday • Up to 3 per day

GOLD

Care Plan

$199/mo
First 30 days FREE

$1,990/year $2,388 save $398

Calls or texts • Monday – Friday • Up to 3 per day

PLATINUM

Premium Plan

$349/mo
First 30 days FREE

$3,490/year $4,188 save $698

Calls or texts • 7 days including holidays • Up to 3 per day

Were you invited for a complimentary enrollment?

⚙️ Communication Preferences

How and when should we reach your loved one?

Communication Type *

📞 Call Only

💬 Text Only

📞💬 Both

Preferred Time *

🌅 Morning

☀️ Afternoon

🌙 Evening

Preferred Days *

Mon – Fri

7 Days

💊 Services Needed

Select all that apply for your loved one

💚

Wellness Check

🍽️

Meal Reminder

🌟

Sobriety Support

🥗

Diet Encourage

🏃

Exercise Remind

📅

Appointments

💊

Medication Reminder

🚨 Emergency Contact

Optional — notified if your loved one needs immediate help

Contact Name

Contact Phone

✅ Consent & Authorization

Required to begin services

🎉

Enrollment Complete!

Thank you for trusting CooloCare with your loved one's care. We'll begin services once payment is confirmed.

Complete Payment →

A confirmation email has been sent to you.