Thank you for choosing Glacier Nurse Direct for your custom nursing needs! Below you will find an intake form regarding the type of assistance you are needing. Please complete in it's entirety. An RN will call you upon receiving it to discuss the next step.
*None of your information will be shared with anyone outside of Glacier Nurse Direct without your written permission. Your privacy is important to us.
Please answer the questions below pertaining to your medical history
Who lives with you in your home? Please list your two primary contacts below or N/A if you live alone:
Glacier Nurse Direct LLP does not bill insurance, Medicaid/Medicare. We are a private nursing service that accepts cash, check, debit, and credit card payments only. Please see our payment & billing policies on our website for further information.