logo

Adult Day Health Care Enrollment Forms

  • Home
  •  
  • Adult Day Health Care Enrollment Forms

How to Enroll

Thank you for your interest in the Oxnard Family Circle’s unique Adult Day Health Care Program. To begin the enrollment process: You may print out the forms (below) and fill  them out before hand, also have your physician fill out, sign, date and return all required forms to us.

You are more than welcome to schedule a tour of our facility to make sure that this is the right place for your loved one. If you have any additional questions feel free to contact us and ask to speak to a social worker.

We are an adult day program that provides supervision, socialization and stimulating activities for your loved one, respite care during the day for caregivers all while ensuring your loved one is safe, secure, and that his or her needs are properly addressed.

[addthis tool="addthis_inline_share_toolbox_6v74"]

ADP Medical Assessment

In the link below we have included the Adult Day Program Medical Assessment Form that can be printed and filled out prior to your visit.

Download

Physician Authorization Form with release of information

In the link below we have included the needed forms for Adult Day Health Care enrollment.

Download

VA Physician Authorization Form

If you are inquiring for a veteran,who is enrolled into the VA Healthcare System, you could use the forms below for enrollment.

Download

Testimonials

  • I thank you all at Oxnard family Circle for the terrific care that you are giving my father and the respect and dignity that you provide him.

    — Jennifer L.

  • We are so happy that our father is spending his days at Oxnard Family Circle. He made so many friends. When bus arrives to pick him up, he almost runs - not walks to get on. For him he is going to work. He is so proud.

    — Carlos R.

  • My mom moved in with me from out of state. I had to stop working to take care of her. After I found the daycare for my mom at Oxnard Family Circle, I was able to go back to work. My mom is getting all the medical care she needs while I am gone.

    — Christina M.

  • For the last two and a half years since my mother started attending Oxnard Family Circle she did not even once went to ER and has her diabetes under control. Thank you so very much for taking such a great care of her.

    — Joy A.
© Copyright 2018 Oxnard Family Circle