Considering a move to senior living is a big decision with many benefits.

This 2-3 minute survey can help as you begin to consider senior living as a new lifestyle option.

Are you looking for a specific level of care? *

Independent Living

Assisted Living

Memory Care

Rehabilitation

I'm not sure

What health concerns do you have about your loved one? Select all that apply.

Mobility

Memory Related Issues

Recent Illness or Injury

Overall Decline

Safety

What social concerns do you have about them?

Loneliness

Recent loss of friends/significant other

Things to do

Emotional connection

Not driving/transportation

What care-needs concerns do you have?

Personal care

Wandering

Medication care

General safety

Mobility Issue

Not driving

Do you have any home maintenance/downsizing concerns?

Inside maintenance/cleaning, repairs

Exterior maintenance/lawncare

Too much stuff/unneeded space

On a scale of 1-10, how ready are you to consider change? (1 is not at all ready. 10 is very ready)

What interests do they have?

Travel

Sports

Music

History

Collections

Art

Games

Trivia

Family

Reading

Television

Movies

What career did they/do they have?

What are their favorite foods?

What kind of music do they like?

What is their favorite book and/or movie?

What keeps you up at night?

How financially ready are you to consider change? (1 is not at all ready. 10 is very ready)

What is your first name? *

What is your last name? *

What is your mobile phone? *

What is your email address? *

Loved One's First Name

Loved One's Last Name