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Instructions for Registration

We truly appreciate and recognize the care and support as a Care Counsellor you are rendering to the elderly families assigned to you. While you are ensuring helping the elderly age comfortably at their own homes., bringing Peace of mind and happiness to families as their own daughter.
As a thanking gesture, we offer to you complimentary Care Plus Plan – a reliable assistance to make life easy and provide support for your own parents and in-laws. You can register your families at the below ink to inititate the plan. By registering for the plan, you are agreeing to abide by the terms and conditions of the plan.

Once you have submitted the details in the following form, the Samarth team will contact you for verification of information, eligibility or further details before initiating the onboarding process.

Please proceed to provide the information for registration below, filling the form accurately.

Thank you

    Your Name *

    Your Care Counsellor Agreement Number *

    (This number is at the bottom of your Care Counsellor Agreement. To sign the new Agreement, click here )

    Your Email * (as per Samarth records)

    Enroll Your Parents

    YesNo

    Enter Parents' Address*

    Enroll Your Mother

    Name *

    Email Mobile No

    Date of Birth *

    Enroll Your Father

    Name*

    Email Mobile no

    Date of Birth*

    Enroll Your In-Laws

    YesNo

    Enter Your In-Laws Address*

    Enroll Your Mother-in-Law

    Name*

    Email Mobile No

    Date of Birth*

    Enroll Your Father-in-Law

    Name*

    Email Mobile No

    Date of Birth*

    Request free consultation

    Fill out the form below, and we will be in touch shortly.

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