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Senior Home Care Finders Wa

Senior Home Care Finders Wa

Welcome to senior care home finders

Full Name*

Your Relationship to the Senior (e.g., Son, Daughter, Spouse, Guardian, Other): *

Best Phone Number to Reach You:*

Your Email Address*

Senior's Full Name

Senior's Current Location (City, State, Zip Code)*

Age of Senior*

Gender*

Male

Female

Non-binary

Prefer not to say

What is the senior's current living situation?*

Lives alone or with family

Lives with spouse/partner or Currently in a facility (e.g., hospital, rehab, nursing home)

Other

What type of care are you primarily seeking? (Select all that apply)*

Assisted Living Facility (daily support, social activities, some medical care)

In-Home Care (caregivers come to senior's home)

Memory Care (specialized care for dementia/Alzheimer's)

Independent Living (minimal support, focus on community)

Nursing Home/Skilled Nursing Facility (high level medical care)

Respite Care (short-term care)

Other/Unsure

When are you looking for care to begin?*

What are the primary reasons you are seeking care for the senior?*

Does the senior have any known cognitive impairment (e.g., dementia, Alzheimer's)? Briefly ecplain your answer.*

Financial Considerations (Crucial for Lead Quality) * What is your estimated monthly budget for senior care? (This helps us narrow down options significantly.)*

Below $5,000

$5,000 - $10,000

Above $10,000

Unsure/Need more information

How do you plan to pay for senior care? *

Agreeing to terms*

By submitting this form, I agree to be contacted by SENIOR CARE HOME FINDERS via phone, email, or text message regarding senior care options. I understand that my information will be kept confidential.

Welcome! We understand that finding the right care for your loved one is a significant decision. To help us best understand your needs and connect you with the most suitable options, please take a few moments to complete this confidential questionnaire.

Your privacy is important to us. All information submitted will be kept strictly confidential.

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Welcome to senior care home finders

Your privacy is important to us. All information submitted will be kept strictly confidential.

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