Companionship Registration - Eyemates Foundation

Companionship Services

Hospital/Outdoor Companionship Registration

At EYEMATES FOUNDATION, we understand the challenges of attending hospital visits, medical check-ups, or other outdoor activities alone. Our compassionate companionship services are designed to provide comfort, safety, and emotional support to individuals who need assistance during these times What We Offer:

· Assistance with hospital formalities and paperwork.

· Support during doctor consultations and medical procedures.

· Coordination with medical staff or relevant personnel.

· Emotional encouragement and care throughout the process.

Service Rates:

· Daytime Service (Morning to Evening): ₹1,250/-

· Full-Day Service (24 Hours): ₹1,500/-

Note: Food expenses will be covered separately, and additional transportation charges may apply for out-of-station travel based on distance.

How to Request Our Services:

1. Fill out the Hospital/Outdoor Companionship Request Form available on our site.

2. Ensure all required fields are completed.

3. Submit the form at least24 hours before the service date.

4. Once we receive your request, our team will contact you to confirm the booking.

Let EYEMATES FOUNDATION be your trusted companion in moments that matter most. We’re here to ensure you never have to navigate these experiences alone.

Hospital/Outdoor Companionship Requisition Form

Name of the Patient/Stake Holder *

Date of Birth *

Gender *

Address *

Phone Number *

Email *

Hospital Name or Location of Visit *

Preferred Emergency Requirement

Purpose of the Visit: *

Requirement *

Number of Days Required *

Preferred Date(s) *

Pickup Location *

Describe Medical History of Patient/Stake Holder *

Personalised Needs Expected from Companion *

Emergency Contact Person Name *

Relationship to the Elderly Person *

Emergency Contact Number *

Gender Preference *

Name of the Applicant *

Relation with Applicant and Patient/Stake Holder *

Declaration *

I hereby declare that all the information provided in this form is true to the best of my knowledge. I agree to disclose all relevant details about my/patient’s health, needs, and requirements to the companion. I understand that the companion will assist only with the agreed tasks and will not perform medical treatments or manage emergencies. I acknowledge that any risks or incidents occurring during the companionship service are my sole responsibility and do not hold the EYEMATES Geriatric Care Team liable, either directly or indirectly.

Kindly transfer the payment to the following bank account after confirming the availability of your companion:

EYEMATES FOUNDATION FOR RESEARCH AND DEVELOPMENT

Bank Transfer Details:
Account Number : 20530601678
Bank : State Bank of India
Branch : Monippally
IFSC : SBIN0070134

(OR)

UPI Payment Options:
UPI ID 1: 9074774237@sbi
UPI ID 2: eyemateseyemates@sbi