Home Care package - Client Choice of Approved Provider SELECTIONForm

Please indicate your choice of provider in the order that you would prefer them to provide your Home Care service. The list below is in alphabetical order. All Providers listed are compliant with the standards defined by the HSE. Please indicate your choice in order of preference, by inserting 1 for first preference, 2 for second preference and so on in the column titled “client choice”.

CHO 2 – Galway, MAyo, Roscommon
Approved Provider-Alphabetical Order / Address / Approved Provider TelePHONE NUMBER / Client Choice
A Home Instead Senior CareService (Consortium) / Unit 9 G Racecourse Business Park, Suite 4, Parkmore, Galway / 1800 911797
Allied Therapeutic Homecare Consortium (Consortium) / Unit 16A, Sandyford Business Centre, Bohermore, Galway / 1800 400900
Bluebird Care(Consortium) / Block 6, Galway Technology Park, Parkmore, Galway / 1800 819 310
Care Group West (Consortium) / Derrane, Co Roscommon / 090 6625852 Extn 220
Caremark (Consortium) / Gray Office Park, Galway Retail Park, Headford Road, Galway / 091 771704
Carrabawn Homecare Ltd t/a Right at Home (Galway) / 7 Mulvoy Park, Sean Mulvoy Road, Galway / 086 8762000
Family Carers Ireland / Barrack Street, Loughrea, Co Galway / 091 880418
Irish Wheelchair Association / Cul Ard, Wellpark, Galway / 091 771550
RHS Home Care / Primary Care Centre, Golf Links Road, Roscommon / 090 6625988
If you do not wish to choose a Provider please insert “X” below and leave above spaces blank
I do not wish to choose a provider and HSE should randomly select a provider for me from the list.
Signed by Client:
Client Address:
Date Signed:

The HSE will need to share your relevant information with selected Providers in order to put in place your Home Support. Please indicate by inserting “X” in the box provided that you are happy for the HSE to do so.

A consortium is a group of providers working together to provide services across an area. The members of each consortium are listed under the heading “Additional Information – Consortium Members”.

Additional Information - Consortium Members

The following information is provided solely to inform clients of the names of the providers who form the consortium on the Approved Provider Listing.

Consortium / Members of Consortium
A Home Instead Senior CareService (Consortium) / Home Instead Senior Care Galway, Home Instead Senior Care Mayo, Home Instead Senior Care Sligo/Leitrim
Allied Therapeutic Homecare Consortium (Consortium) / All About Healthcare Ltd t/a The Care Team; Flanagans Nursing Home Ltd t/a Home Assist Healthcare; Resot Ltd t/a Contact Care; Servisource Healthcare t/a Myhomecare
Bluebird Care(Consortium) / Bluebird Care Galway; Bluebird Care Mayo; Bluebird Care Roscommon
Care Group West (Consortium) / Co Roscommon Disability Support Group Ltd; Galway Centre of Independent Living
Caremark (Consortium) / Raytoon Ltd T/A Caremark, Purple Acorn Ltd T/A Caremark Dublin South East, JK Homecare Ltd T/A Caremark Kildare, Caspian BMP Ltd T/A Caremark Galway & O’Shea Care Ltd T/A Caremark Cork

If you need help to complete this form please contact

(CHOto insert contact name and number)

Please return completed form to: (CHO to Insert details)