New LifeStyles - New York

Winter/Spring 2015

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56 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 Retirement/Independent Living m Assisted Living Community m Alzheimer's/Dementia Care m Nursing/Rehab m Residential Care Home m Home Health Care m Other___________________________________________________________ City/Area(s) of Interest: _____________________________________________ ___________________________________________________________________ OR Community/Provider Name(s): ______________________________________ ___________________________________________________________________ ___________________________________________________________________ This information is for: Anticipated Move Date: m Myself m Less than 1 month m Parents(s) m 1-3 months m Relative/Friend m 4-6 months m Other m 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 : 800-869-9549 - NYO w/s 2015 ‚úČ !

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