Help and Referrals from SeniorsResourceGuide.com

Thank you for your interest in SeniorsResourceGuide.com. Please fill out and submit the information form below. We do not sell or distribute your name and email address to organizations outside the SeniorsResourceGuide.com network.

We are very proud of our system of answering all e-mail inquiries and we do our best to answer all email. However, we have noticed that sometimes our reply emails bounce due to intermittent mail transfer outages or to overactive SPAM filtering systems that may be turned on. To ensure that you get a response to your request, we ask you to provide a phone number.

If you prefer use our short contact form.

Required Fields Indicated by *

Your Contact Information

Name *

Email *

Phone Number (daytime)*

Address *

City *

State *

Zip Code *

Inquiry Details

I am inquiring for *
Self   Friend   Relative

If for a relative, what is the relationship?

If for other than you, what is the first name and age of the person for which this this inquiry is made?
First Name      Age 

Please provide the desired location for the senior housing, services or products to be provided *.

On which of our topics do you want information?

Senior Housing
Continuum of Care Assisted Living
Retirement Communities Skilled Nursing
Active Independent Living Alzheimer's Assisted Living
Subsidized Housing Alzheimer's Skilled Nursing

How much have you budgeted for these types of housing services? To better assist you we need to know your approximate housing budget.
Less than $1,000 a month
$1,000 to $3,000
$3,000 to $5,000
$5,000 and over

Are you looking for income qualifying housing, such as HUD?
Yes No

Please enter a city or geographic area such as 'Fort Myers, FL' or 'North Denver'.

Health at Home
Home Health/Caregiver Ambulatory Aids (such as wheelchairs and walkers)
Homemakers & Companions Diabetic Supplies
Emergency Response Systems Home Medical Equipment

Health Services
Adult Day Programs Rehabilitation
Hospitals Dental Resources
Hospices Hearing Resources
HMOs and Health Insurance Vision Resources
Prescription Assistance Respite Care

Professional and Advisory Services
Care Management Moving Services
Elder Law Funeral & Preplanning Services
Estate Planning Real Estate Services
Financial Planning Reverse Mortgages
Long-Term Care Insurance  

Other – please describe your needs:

Other Information

When do you expect to need senior housing, service(s) or product(s)?
Now   In the Next 6 Months   6 to 12 months

If you are in need of senior housing or home health care,
what type of funding will you use?

Private Pay Medicare
Long Term Care Insurance Medicaid or Public Assistance
Health Insurance Veteran Benefits

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