logo slogan
    Login | Sign Up

Free Forms

FormsFirst of all, I would like to thank you for visiting the Sallycares.com family.  

It is my intention to help you with the difficulties that you are having managing your care at home.  

I do not want you to ever alter or change the information you have been given by your treating medical professionals, due to something that you have read on our web site. 

Our information is meant to be educational, and if you would like to look into treatment alternatives in your area, realize that you are doing that at your own risk. 

You should keep your physician’s office involved with all of the medical decisions that you make.

If you need direction regarding how to locate information for your specific questions, please use the “Contact Us” Tab on the home page of the web site.  Your questions will be answered by one of our staff members within 24-48 hours.

To begin to problem solve your situation, we need to start at the beginning.  We need to define what the problem is.  You may feel that there are “too many to count,” but I would encourage you to believe that if you feel that way, you are over whelmed. 

Let’s approach this by looking at the actual physical limitations the patient has, that you are caring for.  Go to the Free Forms Tab if you are visiting the site;

Click on the Patient’s Physical Limitations Form:  You will see a form that you can complete to document the patient’s status.

Then I want you to click on the Caregiver’s Comments Form, and complete that form as well.

The answers on those two forms will be our starting point to get to know your concerns and your needs.You can share your answers with us if you would like, or keep them in a file at home for you to reference as you try to develop a plan to manage those things that concern you.  After you complete these forms, use MyGoal Chart to get started.

If you join Sallycares.com, we can store your information in your file at Sallycares.com.

You can fax your completed forms to (941)492-2433 or email your completed forms back to us.

If you have chosen to join as a Platinum Member, that membership includes direct review of your situation by Sally, when you send us photos and/or videos of the challenges you are having. 

Whatever you choose to do, we certainly want to help both the patient and caregiver, problem solve their home management issues, and we look forward to working with you!

Kind Regards,

Sally     Let’s Get Going” J

Organize and track your medications, symptoms and outcomes. Print the forms that you feel will help you, and fill them out before your medical appointments. You will save time and get more out of your visit.  

Caregivers Comments Form

Download Form
My Goal Chart Form

Download Form
Patients Physical Limitation Form

Download Form

Sallys Stuff

Senior Citizens Discounts

This information was passed along to us; we thought this would be interesting information to post on our website, since we all love a good deal!

In order to receive the Senior Citizen discounts listed below, you have to mention the discount prior to paying.

If you find that some of these locations do not offer the discount any longer, or if you come across a vendor that should be added to the list, please go the “Contact US” Tab on the homepage of the website.  Send us an email, for a vendor to be added or removed. Happy Shopping& Saving! ~ From the staff at Sallycares.com


RESTAURANTS:
Applebee's: 15% off with Golden Apple Card (60+)
Arby's: 10% off ( 55 +)
Ben & Jerry's: 10% off (60+)
Bennigan's: discount varies by location (60+)
Bob's Big Boy: discount varies by location (60+)
Boston Market: 10% off (65+)
Burger King: 10% off (60+)
Chick-Fil-A: 10% off or free small drink or coffee ( 55+)
Chili's: 10% off ( 55+)
CiCi's Pizza: 10% off (60+)
Denny's: 10% off, 20% off for AARP members ( 55 +)
Dunkin' Donuts: 10% off or free coffee ( 55+)
Einstein's Bagels: 10% off baker's dozen of bagels (60+)
Fuddruckers: 10% off any senior platter ( 55+)
Gaetti’s Pizza: 10% off (60+)
Golden Corral: 10% off (60+)

Hardee's: $0.33 beverages everyday (65+)
IHOP: 10% off ( 55+)
Jack in the Box: up to 20% off ( 55+)
KFC: free small drink with any meal ( 55+)
Krispy Kreme: 10% off ( 50+)
Long John Silver's: various discounts at locations ( 55+)

McDonald's: discounts on coffee everyday ( 55+)
Mrs. Fields: 10% off at participating locations (60+)
Shoney's: 10% off
Sonic: 10% off or free beverage (60+)
Steak 'n Shake: 10% off every Monday & Tuesday ( 50+)
Subway: 10% off (60+)
Sweet Tomatoes: 10% off (62+)
Taco Bell : 5% off; free beverages for seniors (65+)
TCBY: 10% off ( 55+)
Tea Room Cafe: 10% off ( 50+)
Village Inn: 10% off (60+)
Waffle House: 10% off every Monday (60+)
Wendy's: 10% off ( 55 +)
Whataburger: 10% off (62+)
White Castle: 10% off (62+)

RETAIL & APPAREL :
Banana Republic: 30% off ( 50 +)
Bealls: 20% off first Tuesday of each month ( 50 +)
Belk's: 15% off first Tuesday of every month ( 55 +)
Big Lots: 30% off
Bon-Ton Department Stores: 15% off on senior discount days ( 55 +)
C.J. Banks: 10% off every Wednesday (50+)
Clarks : 10% off (62+)
Dress Barn: 20% off ( 55+)
Goodwill: 10% off one day a week (date varies by location)
Hallmark: 10% off one day a week (date varies by location)
Kmart: 40% off (Wednesdays only) ( 50+)
Kohl's: 15% off (60+)Modell's Sporting Goods: 30% off
Rite Aid: 10% off on Tuesdays & 10% off prescriptions
Ross Stores: 10% off every Tuesday ( 55+)
The Salvation Army Thrift Stores: up to 50% off ( 55+)
Stein Mart: 20% off red dot/clearance items first Monday of every month ( 55 +)

GROCERY :
Albertson's: 10% off first Wednesday of each month ( 55 +)
American Discount Stores: 10% off every Monday ( 50 +)
Compare Foods Supermarket: 10% off every Wednesday (60+)
DeCicco Family Markets: 5% off every Wednesday (60+)

Food Lion: 60% off every Monday (60+)

Fry's Supermarket: free Fry's VIP Club Membership & 10% off every Monday ( 55 +)
Great Valu Food Store: 5% off every Tuesday (60+)
Gristedes Supermarket: 10% off every Tuesday (60+)
Harris Teeter: 5% off every Tuesday (60+)
Hy-Vee: 5% off one day a week (date varies by location)
Kroger: 10% off (date varies by location)
Morton Williams Supermarket: 5% off every Tuesday (60+)
The Plant Shed: 10% off every Tuesday ( 50 +)
Publix: 15% off every Wednesday ( 55 +)
Rogers Marketplace: 5% off every Thursday (60+)
Uncle Guiseppe's Marketplace: 15% off (62+)

TRAVEL :
Airlines:
Alaska Airlines: 50% off (65+)
American Airlines: various discounts for 50% off non-peak periods. (Tuesdays - Thursdays) (62+)and up (call before booking for discount)
Continental Airlines: no initiation fee for Continental Presidents Club & special fares for select destinations.
Southwest Airlines: various discounts for ages 65 and up (call before booking for discount).
United Airlines: various discounts for ages 65 and up (call before booking for discount).
U.S. Airways: various discounts for ages 65 and up (call before booking for discount)

Rail:
Amtrak: 15% off (62+)

Bus:
Greyhound: 15% off (62+)
Trailways Transportation System: various discounts for ages 50+

Car Rental:
Alamo Car Rental: up to 25% off for AARP members
Avis: up to 25% off for AARP members
Budget Rental Cars: 40% off; up to 50% off for AARP members ( 50+)
Dollar Rent-A-Car: 10% off ( 50+) Enterprise Rent-A-Car: 5% off for AARP members Hertz: up to 25% off for AARP members
National Rent-A-Car: up to 30% off for AARP members

Overnight Accommodations:
Holiday Inn: 20-40% off depending on location (62+)
Best Western: 40% off (55+)
Cambria Suites: 20%-30% off (60+)
Waldorf Astoria - NYC $5,000 off nightly rate for Presidential Suite (55 +)
Clarion Motels: 20%-30% off (60+)
Comfort Inn: 20%-30% off (60+)
Comfort Suites: 20%-30% off (60+)
Econo Lodge: 40% off (60+)
Hampton Inns & Suites: 40% off when booked 72 hours in advance
Hyatt Hotels: 25%-50% off (62+)
InterContinental Hotels Group: various discounts at all hotels (65+)
Mainstay Suites: 10% off with Mature Traveler's Discount (50+); 20%-30% off (60+)
Marriott Hotels: 25% off (62+)
Motel 6: Stay Free Sunday nights (60+)
Myrtle Beach Resort: 30% off ( 55 +)
Quality Inn: 40%-50% off (60+)
Rodeway Inn: 20%-30% off (60+)
Sleep Inn: 40% off (60+)

ACTIVITIES & ENTERTAINMENT :
AMC Theaters: up to 30% off ( 55 +)
Bally Total Fitness: $100 off memberships (62+)
Busch Gardens Tampa, FL: $13 off one-day tickets ( 50 +)
Carmike Cinemas: 35% off (65+)
Cinemark/Century Theaters: up to 35% off
Massage Envy - NYC 20% off all "Happy Endings" (62 +)
U.S. National Parks: $10 lifetime pass; 50% off additional services including camping (62+)
Regal Cinemas: 50% off Ripley's Believe it or Not: @ off one-day ticket ( 55 +)
SeaWorld, Orlando , FL : $3 off one-day tickets ( 50 +)

CELL PHONE DISCOUNTS :
AT&T: Special Senior Nation 200 Plan $19.99/month (65+)
Jitterbug: $10/month cell phone service ( 50 +)
Verizon Wireless: Verizon Nationwide 65 Plus Plan $29.99/month (65+).


MISCELLANEOUS:
Great Clips: $8 off haircuts (60+)
Supercuts: $8 off haircuts (60+)

You are on your way to a Free Consultation!

Fill out the form below and you will be scheduled.

* * * *