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Please take some time and fill out our form.   Patty Care will contact you and address your questions and concerns as soon as possible!

Privacy Information:
PATTY CARE does collect personal data on persons visiting this website.  If you choose to contact us through the form below, e-mail or by submitting forms through US Mail, the information you provide will only be used by PATTY CARE for fulfilling your request and subsequent communication as needed related to the request. Your information will then be stored at PATTY CARE and will not be given or sold to any other companies or individuals. Should you have any questions about the use of this information, please call us, (262) 242-1923.


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FIRST NAME:

   
LAST NAME:
   
PHONE:
   
EMAIL:
   
WHO ARE YOU       SEEKING INFO FOR? Myself
Client
Family Member
   
Following Questions pertain to the Client needing assistance:
MALE
FEMALE
   
AGE: Under 65   65-70   71-80
  81-90        91-100  100+
   
WHAT KIND OF CARE IS NEEDED?

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