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Assessment Questionnaire
What type of living do you need?
Independent Living
Assisted Living
Memory Care
Radio button 1
Ambulatory/Mobility
No assistance required
Walker/cane
Wheelchair
Bed ridden
Assistance Needed - Check all that apply:
Medication assistance
Dressing
Incontinent care
Meal preparation
Assistance with eating
Transferring
Taking showers or baths
Hygiene assistance
N/A
I accept terms & conditions
Submit Answers
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