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Contact Us

Use the form on the right to contact us with general questions or select from the links below for specific services.

Home Health

Private Services

Hospice

Messages will be answered as soon as possible. For urgent matters please call:

636-926-3722 in St. Charles

314-685-3722 in St. Louis

or

618-310-1591 in Illinois

Name *
Name
Phone
Phone
Address
Address

115 Piper Hill Drive Suite 200
St. Peters, Mo 63376
United States

(636)926-3722

1 Company 3 Services. Nurses & Company provides Home Health, Hospice and Private Service Care to the great St. Louis and St. Charles area. As a locally owned and operated company we are proud to care for our neighbors each day. Let us be a part of your health care journey and experience our continuity of care.

Medical Questionnaire

Private Services Portal      401K Eligibility  Incident Report    Grievance Form    Coworker Kudos   Time Off Request 

Mileage     Task Codes      Birthdays & Anniversaries      Personnel Policies        Who's Who?        Meeting Video

 

 

Complete the form below and submit to email it to the Private Service Office or Click Here to print a copy of the form to mail, fax or drop off at the office.

History Record
Full Name *
Full Name
Date *
Date
Address *
Address
Previous History: Have you ever had any of the following diseases? If yes, specify date and details.
Have you ever recieved workers' compensation? *
Have you ever been medically rejected for employment of life insurance?
Are you currently being treated for any medical problems?
Dates of Last Immunizations
To my knowledge, the above medical history is accurate. I am able to perform duties as listed in my job description.
By submitting this form I am electronically signing this document.
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