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1 Step 1
Care Placement Tool

(Just 3 minutes)

Take 3 minutes to help you make the right decision for you or your loved one.  We will help you navigate all of the many options available to you and contact you right away! 


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Tell Us Your Needs
What Type of Care?Check All That Apply
Otheryour full name
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How many seniors need care?
Nameyour full name
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Ageyour full name
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Relationship to senioryour full name
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Weightyour full name
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Nameyour full name
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Ageyour full name
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Weightyour full name
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Relationship to senioryour full name
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Is the senior or their spouse a Veteran?
What Type of Care?
Do they require injections?
In order to get the care they need, this person:
What are the biggest challenges you will face in making the transition?
Budget
Based on your budget, what’s the MINIMUM class of community you are looking for?Select all that apply
What is your MAXIMUM PER PERSON monthly budget?This will not stop us from finding lower cost options as long as they can provide adequate care for your loved one’s needs
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What funding source(s) do you plan to use to cover the senior living costs?Select all that apply
Activities of Daily Living
ActivityActivity
Accomplishes Alone Needs Some Help Needs Much Help
Bathing
Getting Dressed
Feeding Self
Eating a nutritious diet
Walking
Using the toilet
Getting out of bed or a chair
Taking medications
Competency
ActivityActivity
Good Moderate Poor
Health
Mobility
Balance
Memory
Managing daily activities
Managing medications
Decision making
Managing finances
Unique CareSelect all that apply
Any additional information you’d like us to know?
Commentsmore details
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Tell Us About You
Nameyour full name
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Phone Number
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When's the Best Time to Reach You
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