Services Testimonials Find A Facility Contact Us Home

Thursday, September 2nd, 2010 Adjust Type Size

HOME ABOUT US SENIOR LIVING FAQS PRIVACY POLICY EHF INFO MORE NEWS USEFUL LINKS

Please fill out this quick assessment form to find a quality care facility in your area. Our caring and experienced family advisors are Available 7 days a week, at no charge, to help you make the best choice for your loved one. _ _(310) 699-3000 ASSESSMENT FORM (888) 823-5337 Your Contact Information (*indicates required fields) *Your First Name Last Name Address City State Zip Home Phone *Cell Phone *Valid Email Address Relationship to Elder (s) Senior's Information Note: Medicare and Medi-cal do not pay for residential assisted living costs. *First Name Last Name Age Bathing Assistance Select Assistance None Some Full Dressing Assistance Select Assistance None Some Full Taking Medications Select Assistance None Some Full Mobility Select One Walks unaided Uses a cane Walker Wheelchair Non-ambulatory Using the Toilet Select Assistance None Some Full Memory Loss Select one None Some Dementia Alzheimers Wanderer *Monthly Budget *City Choices *Have you contacted other referral agencies? Yes No Additional Comments If you do not enter in the required information-our advisor will not be able to contact you. Continuing Care Retirement Community

© 2010 ElderHomeFinders.com Disclaimer | Articles