Tell us about your loved one.

This takes about 5 minutes. Your answers help us prepare for your consultation so we can focus on what matters most — your family.

About you.

You're reaching out on behalf of a loved one. Let's start with your contact details so Magda can reach you directly.

Please enter your first name.
Please enter your last name.
Please enter a valid email address.
Please enter a phone number.
Please select your relationship.
This helps us confirm we serve your area.
Step 1 of 4

About your loved one.

Tell us a little about the person who needs care. This helps us understand their situation before we speak.

Please enter the patient's first name.
Please enter the patient's age.
Please select a living situation.
No medical jargon needed — just tell us what's going on in your words.
Step 2 of 4

Their care needs.

Select everything that applies. Don't worry if you're not sure — we'll figure it out together on the call.

List as many as you know. This is not a medical record — just gives us context.
If a friend or family member referred you, we'd love to know who — so we can thank them.
Step 3 of 4

When can we reach you?

Almost done. Help us find the best time to connect — and share anything else on your mind.

This helps us recommend the right tier — no pressure, no judgment.
Step 4 of 4