ONLINE INTAKE FORM

SENIOR LIVING OPTIONS & CARE SOLUTIONS

ONLINE INTAKE FORM

By completing the form below, we will be able to assess your needs and tailor senior living options for you or your loved one. Once you complete the form one of our Senior Advisors will be in contact with you to discuss the options and help you move forward in the process.

Our services are NO COST to you.

Who are you completing this intake form for?
What is their age?
Means of paying for care? (Check all that apply)
How quickly are services needed?
Which county are you seeking service in? (Check all that apply)
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In the last 90 days hve they been admitted to any of the following?
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Do they need assistance with any of the following?
Do they have any of the following conditions?
Tell us about their mobility?
Do they have any challenging behaviors?
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MEET OUR TEAM

Meet our educated and compassionate Senior Advisors! With many years of experience, our team is ready to help you make the right choice for your loved one.

HAVE QUESTIONS?

Check out our Frequently Asked Questions page to find answers to some of your common questions.

LEARN MORE

Did you know we have a blog? We discuss all things senior living, adult family homes and things to look for before seeking help for your loved one.

HEADQUARTERS

1634 PORTER STREET, SUITE C

ENUMCLAW, WA 98022

CONTACT

1-866-611-1634

TAMI@SENIORHOUSINGSPECIALISTS.COM

 OFFICE HOURS

MONDAY - FRIDAY

9AM - 5PM

 

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