New LifeStyles - Kansas City

Winter/Spring 2016

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Simply complete this form and return it to New LifeStyles to receive detailed information from the communities or providers that meet your criteria. Seeking information for: (check all that apply) ❍ Retirement/Independent Living ❍ Assisted Living Community ❍ Alzheimer's/dementia Care ❍ Nursing/Rehab ❍ Residential Care Home ❍ Home Health Care ❍ Other___________________________________________________________ City/State/Area(s) of Interest: _______________________________________ ___________________________________________________________________ OR Community/Provider Name(s): ______________________________________ ___________________________________________________________________ ___________________________________________________________________ This information is for: Anticipated Move Date: ❍ Myself ❍ Less than 1 month ❍ Parents(s) ❍ 1-3 months ❍ Relative/Friend ❍ 4-6 months ❍ Other ❍ More than 6 months Name______________________________________________________________ Address_____________________________________________________________ City_______________________________State__________Zip_________________ Phone (optional)_________________________________Date__________________ E-mail:______________________________________________________________ Where did you obtain your copy of New LifeStyles? ________________________ Information Request Mail completed form to: New LifeStyles, Attn: Customer Care 4144 N. Central Expressway, Suite 1000 Dallas, TX 75204 Or FAX to: 866-817-8285 Phone: 1-800-869-9549 ✍ KCI W-S 2016 ✉ ✁ 60

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