The sunshine connection form

Welcome to Phone A Friend in the Heartland! We're delighted you're considering our friendly phone companionship service for yourself or a loved one. Please fill out this form so we can better understand your needs and schedule a 15-minute discovery call to discuss how we can bring a little more sunshine into someone's day.

For seniors & family members

This form is designed for both seniors interested in our services and their caring family members. We aim to make connection easy and accessible for everyone.

Schedule your discovery call

After submitting the form, we'll reach out to schedule a brief 15-minute Discovery Call. This is a chance for us to chat and see how Phone A Friend in the Heartland can best support you.

📋 The Heartland "Getting to Know You" Questionnaire

Introduction: To provide the best connection possible, we’d love to learn the "little things" that make your loved one who they are. There are no wrong answers! The more we know, the better we can make every call feel like catching up with an old friend.

Notice: We are currently experiencing technical difficulties with our online form. To ensure we receive your information and can assist you right away, please call us directly at 515-220-7440. We will be happy to go over the form with you over the phone!

🌻 Let’s Start a Conversation

Whether you’re looking for a little extra sunshine for yourself or peace of mind for a loved one, we’d love to hear from you. Fill out the form below, and I will personally reach out to see how we can help.

1. About You

  • Your Name: ________________________________________________
  • Your Email: _______________________________________________
  • Phone Number: ____________________________________________
  • I am inquiring for: * [ ] Myself
    • [ ] A Parent or Loved One
    • [ ] A Client/Professional Referral

2. About the Senior (The Star of the Show!)

  • Their Name: ______________________________________________
  • General Location (State/Time Zone): ________________________
  • What makes them smile? (Hobbies, pets, favorite memories):

3. Finding the Right Fit

  • Which plan are you most interested in?
    • [ ] Simply Sweet (Weekly check-in)
    • [ ] The Neighborly Plan (Deeper weekly connection)
    • [ ] The Heartland Plan (Two calls per week)
    • [ ] The Heartland Legacy Plan (Three calls + The Legacy Book)
    • [ ] I’m not sure yet!

4. Your Story

  • Is there anything specific you’d like us to know? (e.g., "Mom loves talking about her garden," or "I live out of state and want someone to check in."):

5. Best Way to Connect

  • How would you prefer I reach out to you?
    • [ ] Phone Call
    • [ ] Text Message
    • [ ] Email

 

  • The Heartland Connection Checklist

    Please check all boxes that apply to your loved one so we can tailor our "Sunshine Calls" to their favorite things!

    1. Favorite Conversation "Sparklers"

    Select the topics that always bring a smile:

    • [ ] Local History: Small-town life, "the good old days," or how things have changed.

    • [ ] Career Pride: Their life’s work, trade secrets, or favorite coworkers.

    • [ ] Victory Stories: Sports wins, awards, or overcoming a big challenge.

    • [ ] Creative Joys: Quilting, woodworking, painting, or baking.

    • [ ] The Great Outdoors: Fishing, gardening, birdwatching, or farming.

    • [ ] Travel & Maps: Favorite road trips, military stations, or dream vacations.

    • [ ] Animal Friends: Current pets, childhood farm animals, or favorite breeds.

    • [ ] Faith & Community: Church activities, choir, or volunteer work.

    2. The "Era" & Entertainment Tracker

    Which "times" or styles resonate most with them?

    • [ ] The 1940s/50s: The Big Band era, post-war memories, classic radio.

    • [ ] The 1960s/70s: Classic rock, moon landings, family car trips.

    • [ ] Classic Cinema: Westerns (John Wayne!), musicals, or black-and-white comedies.

    • [ ] Simple Pleasures: Watching the birds, a good cup of coffee, the morning paper.

    • [ ] Modern News: Staying up-to-date on current events and local happenings.

    3. Communication Style & Needs

    How should our Senior Pals best connect?

    • [ ] The "Storyteller": They love to lead the chat and tell long, detailed stories.

    • [ ] The "Listener": They prefer to be asked questions and prompted.

    • [ ] The "Wit": They enjoy jokes, puns, and a bit of playful banter.

    • [ ] The "Slower Pace": Please speak clearly and allow extra time for responses.

    • [ ] Hearing Support: High-pitch tones are difficult; please use a lower, steady voice.

    4. The "No-No" List (Sensitive Areas)

    Please check any topics we should avoid or handle with extreme care:

    • [ ] Recent Loss: Spouse, close friend, or a beloved pet.

    • [ ] Health/Medical: They prefer not to focus on "doctor talk" or ailments.

    • [ ] Politics/Religion: They prefer to keep things strictly neutral and light.

    • [ ] Financial Stress: Any mention of "bills" or "costs" causes anxiety.

    • [ ] Memory Frustration: They get upset if they can't remember a name or date.

Beyond the ordinary

This is where our journey begins. Get to know our business and what we do, and how we're committed to quality and great service. Join us as we grow and succeed together. We're glad you're here to be a part of our story.

Our Privacy Promise

"At Phone A Friend in the Heartland LLC, we treat your family’s stories with the same care we’d give our own. The information provided in this form is used exclusively to personalize our companionship calls and—if you’ve chosen a Legacy plan—to help draft your loved one’s Legacy Book. We will never sell, share, or disclose this information to third parties without your express written consent, except as required by law. Your trust is our most valuable asset."

Intellectual Property Notice: All content, including text, service descriptions, pricing structures, and original forms found on this website, is the exclusive property of Phone A Friend in the Heartland LLC. No part of this site may be reproduced, copied, or distributed without the express written consent of the owner.

 

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