CeyCare - Care in Every Meal

CeyCare Application

Apply for personalized care services with ease

Applicant Information

Applicant Name *

Applicant Email *

Applicant Phone *

Password *

Confirm Password *

Country *

Use my details as emergency contact

Emergency Contact Name *

Emergency Contact Phone *

Parent 1 Details

Parent Name *

Phone Number *

Age *

Address *

Dietary Restrictions

Low Salt

Cholesterol

Diabetic Friendly

Vegetarian

Lactose Intolerant

Other

Meal Plan

Breakfast

Lunch

Dinner

Special Instructions

Upload Documents (Optional)

PDF Documents

Add PDF Document

Medical reports, prescriptions, etc. (max 5MB)

Image Documents (JPG/PNG)

Add Image Document

Photo ID, medical images, etc. (max 5MB)