top of page
Home
About Us
Our Services
Initial Questionaire
Resources, Guides & FAQs
Resources and Links
Housing Options
FAQs
Brochure
More
Use tab to navigate through the menu items.
Initial Questionaire
Your Name
*
Email
*
Phone
*
Address
City
Zip
Inquiring For?
Their Age
Urgency of Need
Current Living Situation
Own Home
Home with daily nurse
With friends/family
Hospital
Rehab
Senior Community
Other
Diagnosis / Health Situation
Independent
Dementia / Alzheimer's
Stroke / TIA
Heart Disease / CHF
Parkinson's
Diabetes
Bone Fracture
Other
Required Personal Assistance
Bathing
Medication Management
Dressing
Toileting
Grooming
Incontinence
Feeding
Other
Needs / Conditions
Blindness
Night Time Assistance
Speech Impaired
Ostomy / Catheter
Hearing Impaired
Tracheotomy
Diabetic Management
IV/Tube Feeding
Injections
Hospice
Wound Care
None
Oxygen
Other
Mobility
Independent
Cane/Walker
Wheelchair
History of Falls
Sit to Stand Lift
Hoyer Lift
Assistance Toileting
Transfer Assistance with 1
Transfer Assistance with 2
Mental Status
Sharp
Confused
Forgetful
Social
Wandering
Agitated
Evening Agitation Only
Physically Combative
Verbally Combative
Type of Community
Independent Living
Assisted Living
Memory Care
AFC Home
Respite Care
Continuum of Care
Skilled Nursing
Low Income
Type of Unit
Studio
Semi-Private
Private Bath
1 Bedroom
2 Bedroom
3 Bedroom
Amenities
Meals
Laundry
Housekeeping
Transportation
Outings
Activities
Utilities
Pets
Smoking
Insurance Benefits
Medicare
Medicaid
Medicaid Waiver
Long Term Care Insurance
Veteran
Spouse of a Veteran
Reverse Mortgage
Gross Income (Per Person)
Less than $1,000 per month
$1,000 to $1,500 per month
$1,500 to $2,200 per month
$2,200 to $3,500 per month
$3,500+
Savings / Annuities
None
Less than $10,000
$10,000 - $50,000
$50,000 - $100,000
$100,000+
Other
Geographical Preference
Grand Traverse County
East Traverse City
Leelanau County
West Traverse City
Kalkaska County
Old Mission
Benzie County
Other
Submit
bottom of page