Samarth Select – New Member Onboarding

Welcome to Samarth Select

Let's get everything in place
for your Samarth Life Counselor

You've already spoken with us about what matters to you. This form captures the essentials so your Counselor arrives prepared, not with a blank page.

If something doesn't apply or you'd rather discuss it in person, skip it. Your Counselor will go over everything together.

⏱

Takes about

8–10 minutes

🔒

Your data is

Private & secure

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About you

Your details and where you live. Your Counselor will visit you at this address.

Title Required

First name Required

Last name Required

Mobile number Required

+91

Email address Required

We'll send your care plan summary and app login here

Date of birth

Your home

📍

This address is used to assign your local care team and plan the first visit.

Address line 1 Required

Address line 2 Optional

State Required

City Required

PIN code Optional

Home landline Optional

Your household

Living situation

Live alone

With spouse / partner

With family

Other

Do you have house help at home?

Yes No

Step 1 of 5