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Legal Business Name

Business Owner / Primary Contact Name: ( Not Publicly Available on Young and Blissful )

Owner's Email Address: ( Not Publicly Available on Young and Blissful)

Owner's Phone Number: ( Not Publicly Available on Young and Blissful)

Operating / Brand Name (if It's Different)

Year Established

Type of Business

Solo Practice Group Practice Agency or Organization Small Business or Local Shop Other

Service Delivery Model (Select All That Apply)

In-Home Services In-Clinic / On-Site Virtual / Online Hybrid Other

Who Do You Primarily Support?

Independent Seniors Seniors with Mobility Challenges Seniors with Cognitive Decline Family Caregivers Adult Children Supporting Parents

Profile Description (including 3–5 sentences explaining what makes your service unique):

Business Location( City/ Region/ Country)

Coverage and Service Area (Select One or More):

Local Regional Provincial National Virtual Only

Credentials & Professional Information (Professional Designation With Licensing Number if applicable):

Licensing / Regulatory Body (if applicable):

Years of Experience:

0–2 3–5 6–10 11+

Business Insurance:

Yes No

Accessibility Features (if applicable):

Wheelchair Accessible Barrier-Free Entrance Elevator Access Home Visits Available N/A

Languages Spoken:

English French Italian Spanish Tagalog Chinese ( Mandarin or Cantonese) Russian Persian Hindi, Punjabi Urdu Portuguese Arabic Other

Accepting New Clients ? Wait Time

Yes- Walk In Yes- WithAppointment and Quick Yes- With Appointment and Has Wait Time NO

Website URL

Google Business Profile Link (if available):

Google Review:

5 4 and Over 3 and Over 2 and Over N/A

Social Media Links: (List LinkedIn, Facebook, Instagram)

o Be Displayed Publicly on Your Listing, Please provide booking contact details if different from the business owner’s contact information.

Public Booking Phone Number: (If different from owner’s number)

Public Booking Email

Online Booking Link (Direct Scheduling Link Preferred):

Do you accept online bookings?

Yes No

Licensing & Compliance (Trust & Verification Layer) To ensure transparency and build trust with families, please explain Regulatory College / Governing Body

License Type: (Example: Registered Physiotherapist, RN, RSW, City Permits etc.)

License Number/ Permit Number:

License/ Permit Status:

Verified / Active Pending Expired Not Applicable

Professional Liability Insurance:

Yes No Not Applicable

Accreditations and Award

Service Category Selection

Physiotherapy & Occupational Therapy Medical & Dental Care Mental Health & Wellness Services Home Care & Personal Support Mobility & Accessibility Products Caregiver Support Programs Housing, Retirement & Long-Term Care Transportation Services Technology Help for Seniors Daily Living & Lifestyle Support

Specific Services Offered (Select or list all applicable services) Physiotherapy , Massage & Occupational Therapy

Orthopedic Physiotherapy Post-Surgical Rehabilitation Sports Injury Rehabilitation Chronic Pain Management Arthritis Treatment Neurological Physiotherapy (Stroke, MS, Parkinson’s) Balance & Fall Prevention Therapy Vestibular Therapy (Dizziness, Vertigo) Cardiac Rehabilitation Pulmonary Rehabilitation Geriatric Physiotherapy Home-Based Physiotherapy Virtual Physiotherapy Manual Therapy Dry Needling / Acupuncture Therapy Shockwave Therapy Work Injury (WSIB) Rehabilitation Motor Vehicle Accident Rehab (MVA) Home Safety Assessments Cognitive Rehabilitation Stroke Recovery OT Dementia Care OT Activities of Daily Living (ADL) Training Return-to-Work Programs Hand Therapy ☐ Wheelchair Seating & Positioning Assistive Device Training Functional Capacity Evaluations Aging-in-Place Modifications Fall Risk Assessments Virtual Occupational Therapy Massage Therapy Other:

Specific Services Offered (Select or list all applicable services) Physiotherapy , Massage & Occupational Therapy

Family Physicians Geriatricians Nurse Practitioner Clinics Walk-in Clinics Virtual Doctor Services Chronic Disease Clinics Cardiologists Neurologists Endocrinologists Rheumatologists Pulmonologists Pain Specialists Internal Medicine Specialists Oncology Support Clinics Medical Imaging (X-ray, MRI, Ultrasound) Blood & Lab Testing Sleep Clinics Cardiac Testing General Dentistry Senior Dental Care Denture Clinics Dental Implants Oral Surgery Emergency Dental Care Mobile Dental Services Home Visit Dentistry Optometrists Ophthalmology Clinics Hearing Aid Clinics Audiology Services Low Vision Clinics Other:

Specific Services Offered (Select or list all applicable services) Mental Health & Wellness Services

Individual Therapy Couples Counseling Geriatric Mental Health Trauma Therapy Grief Counseling Addiction Counseling ☐ Caregiver Burnout Therapy Cognitive Behavioral Therapy (CBT) EMDR Therapy Psychiatric Assessments Medication Management Memory Clinics Dementia Behavioral Support Life Coaching Mindfulness Coaching Meditation Programs Stress Management Programs Sleep Therapy Emotional Wellness Coaching Virtual Mental Health Telepsychiatry Remote Group Therapy Other:

Specific Services Offered (Select or list all applicable services) Home Care & Personal Support

Bathing Assistance Dressing Assistance Grooming Support Toileting Assistance Mobility Transfers Medication Management Wound Care Injection Services Catheter Care Post-Hospital Care Palliative Care Nursing Social Companionship Dementia Companion Care Overnight Supervision Respite Care Meal Preparation Light Housekeeping Laundry Assistance Grocery Shopping Errand Services Alzheimer’s Care Parkinson’s Care Stroke Recovery Support End-of-Life Care Disability Support Services Other

Specific Services Offered (Select or list all applicable services) Mobility & Accessibility Products

Walkers Rollators Canes Crutches Wheelchairs (Manual & Power) Mobility Scooters Stair Lifts Ramps Grab Bars Bathroom Safety Equipment Lift Chairs Hospital Beds Smart Fall Detection Devices Emergency Alert Systems Medication Dispensers Hearing Assistance Devices Vision Aids Wheelchair Vans Vehicle Lifts Transfer Seats Other

Specific Services Offered (Select or list all applicable services) Caregiver Support Programs

Caregiver Training Programs Dementia Care Education First Aid & CPR Training Safe Lifting Training Caregiver Support Groups Burnout Prevention Programs Mental Health Counseling Respite Services Short-Term Relief Care Emergency Backup Care Adult Day Programs Care Coordination Case Management Services Government Benefits Assistance Disability Paperwork Support Other

Specific Services Offered (Select or list all applicable services) Housing, Retirement & Long-Term Care

Independent Living Senior Apartments Retirement Communities Age-Friendly Housing Assisted Living Residences Supportive Housing Long-Term Care Nursing Homes Memory Care Facilities Specialized Dementia Units Home Transition Services Senior Relocation Services Downsizing Support Estate Cleanout Services Financial & Placement Services Senior Housing Advisors Placement Consultants Other

Specific Services Offered (Select or list all applicable services) Transportation Services

Medical Transportation Non-Emergency Medical Transport Wheelchair Transport Dialysis Transportation Hospital Transfer Services Personal Transportation Senior Ride Services Assisted Transportation Escort Transportation Mobility Support Transport Stretcher Services Bariatric Transport Volunteer Transport Programs Community Ride Programs Charity Transportation Services Other

Specific Services Offered (Select or list all applicable services) Technology Help for Seniors

Device Support Smartphone Setup Tablet Setup Computer Help Internet & Communication Video Calling Setup Email Setup Online Banking Help Smart Home Support Smart Speakers Setup Home Monitoring Systems Emergency Alert Systems Cyber Safety Scam Prevention Training Password Management Online Privacy Training In-Home Tech Help Onsite Tech Assistance Remote Tech Support Other

Specific Services Offered (Select or list all applicable services) ) Daily Living & Lifestyle Support

Wellness & Fitness Senior Fitness Classes Yoga for Seniors Chair Exercises Balance Training Programs Nutrition Support Meal Delivery Services Dietitian Services Special Diet Programs Grocery Delivery Social Engagement Senior Activity Programs Hobby Groups Community Events Home Services Cleaning Services Yard Maintenance Snow Removal Home Repairs Errands & Convenience Prescription Pickup Personal Shopping Appointment Assistance Other:

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