About Your Loved One

Full Name *

Preferred Name *

Phone *

Age

Gender

Live alone? *

Yes

Your Information (Adult Child)

First Name *

Last Name

Phone *

What is your relationship to your loved one? *

Check-in Preferences & Personalization

Preferred Check-in Time *

How quickly do they usually respond to a text message? *

Is there anything you'd like us to know about them?

Anything we should know about your loved one’s texting habits?

I confirm I have permission to sign my loved one up to receive daily wellness check-in texts from MyAging.

Yes, I’d like occasional tips, updates, and check-in reminders from MyAging.