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
✍
LVE S-S 18
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