Get Assistance in Finding Senior Facilities

Use the form below to submit your information directly to our specialists. Or for faster service call us directly at 805-371-8080

 

Once you submit the form, we will take this information and begin searching for the appropriate options in your area. We will then relay that information to you via e-mail, U.S. Mail, or telephone. Easy!

TYPE OF FACILITY
Resident  
Independent Facility
Assisted Living Facility
Board and Care Residence (Six Residents maximum)
Alzheimers and Dementia Care
TYPE OF UNIT
Resident  
Shared
Private
Studio
1 Bedroom
2 Bedroom
Kitchen or Kitchenette
Pool
Pets
Resident Parking
BASIC SERVICES (Resident 2: Spouse if applicable)
Res. 1 Res. 2  
Meals
Transportation
Activities
Housekeeping and Laundry Services
PERSONAL CARE SERVICES
Res. 1 Res. 2  
No Personal Care needed at this time.
Bathing/Showering Assistance
Dressing
Hygiene Assistance
Assistance with Medication
Helpful Reminders
Incontinent Bladder
Incontinent Bowel
SPECIAL CARE SERVICES
Res. 1 Res. 2  
No Special Care needed at this time.
Cane
Walker
Wheelchair
Oxygen
Special Diet
Diabetic
Colostomy
Catheter
Hospice Services
SPECIAL CARE SERVICES for the MEMORY IMPAIRED
Res. 1 Res. 2  
Diagnosis of Dementia or Alzheimer’s Disease
Risk of Wandering
Combative Behavior
Resident 1 Information
Name
Age

Resident 2 Information
Name
Age

When are you looking to move?
Date *

What CITY/COUNTY do you prefer?


Monthly Budget
$ *

Other information that would be helpful in our search:


*We look forward to sending you this information immediately!
Contact Information
Contact name
 *
Relation
Address
City
Zip
Daytime Phone
 *
Fax
E-mail
 *
Besttime to contact you
   
Release of information:
In order to receive contact by the facilities which meet your needs, we ask you to release the contact information you are most comfortable with:

You must choose at least one:
*

How did you hear about California Senior Living?

You will be returned to the home page upon submission