Issue link: https://www.newlifestylesdigital.com/i/231708
Information Request - 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) m m m m Retirement/Independent Living m Assisted Living Community Alzheimer's/Dementia Care m Nursing/Rehab Residential Care Home m Home Health Care Other___________________________________________________________ City/Area(s) of Interest: _____________________________________________ ___________________________________________________________________ OR Community/Provider Name(s): ______________________________________ ___________________________________________________________________ ___________________________________________________________________ m m m m Myself Parents(s) Relative/Friend Other Anticipated Move Date: m m m m Less than 1 month 1-3 months 4-6 months More than 6 months ! This information is for: Name______________________________________________________________ Address_____________________________________________________________ City_______________________________State__________Zip_________________ Phone (optional)_________________________________Date__________________ E-mail:______________________________________________________________ Where did you obtain your copy of New LifeStyles? ________________________ Mail completed form to: u New LifeStyles, Attn: Customer Care 4144 N. Central Expressway, Suite 1000 Dallas, TX 75204 Or FAX to: 866-817-8285 Phone : 800-869-9549 114 CHI ws 14