Issue link: https://www.newlifestylesdigital.com/i/243955
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) r r r r Retirement/Independent Living r Assisted Living Community Alzheimer's/Dementia Care r Nursing/Rehab Residential Care Home r Home Health Care Other___________________________________________________________ City/Area(s) of Interest: _____________________________________________ ___________________________________________________________________ OR Community/Provider Name(s): ______________________________________ ___________________________________________________________________ ___________________________________________________________________ Anticipated Move Date: r r r r r r r r Myself Parents(s) Relative/Friend Other Less than 1 month 1-3 months 4-6 months More than 6 months ยก 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 72 DET W-S 2014