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PVE-CARES New Member Registration

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PVE-CARES Confidential File Questionnaire

For New Member Registration 2026

 

The Palos Verdes Estates Police Department’s PVE-CARES (Care, Assistance, Resources, Education and Socials) Program is a free service for PVE seniors (65 and older) and dependent adults (18-64). A city sponsored program, staffed with a full time coordinator and community volunteers, working to enrich the lives of our seniors by involving them in the community.

The information provided from this form will be used to create a “Reference File” in a CONFIDENTIAL database.  The aim is to act as a “referral hub” and conduit to the Police Department as well as providing education on how to avoid becoming a victim of elder abuse.

Last Name
 *
First Name
 *
Middle Name
Address
 *
Male/Female:
Male/Female:
Home Phone
Work Phone
Cell Phone
Date of Birth
 *

Age

 *
Email
 *
Name/Address/Phone # of Emergency Contact
 *
Name/Address/Phone # of Relative
 *
Name/Address/Phone of Primary Care Physician
 *
Do you live alone?
Do you live alone?
Have you received a "File of Life"?
Have you received a "File of Life"?
Are you dependent on electricity for medical reasons?
Are you dependent on electricity for medical reasons?
PHYSICAL LIMITATIONS
Are you able to drive?
Are you able to drive?
If no, method of transportation?
If no, method of transportation?
Do you have problems with mobility?
Do you have problems with mobility?
If yes, which aid do you use?
If yes, which aid do you use?
CAREGIVER INFORMATION
Do you currently receive assistance from a Caregiver?
Do you currently receive assistance from a Caregiver?
If yes, select who Caregiver is:
If yes, select who Caregiver is:
Name of Caregiver and/or Agency Name
If Caregiver is a paid professional, is the individual who assists you:
If Caregiver is a paid professional, is the individual who assists you:
What type of assistant could PVE-CARES provide for you?

Penal Code Section 368 defines Elder Abuse as not only physical abuse, but also includes the infliction of mental suffering, physical and mental neglect, and theft or embezzlement.

 

Elder is defined by the Penal Code as anyone 65 years of age or older

PVE-CARES

340 Palos Verdes Drive West | Palos Verdes Estates, CA 90274-1299 | (310) 378-4211

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