Senior Living Consultants: CareSenior Placement forIndependent Living, Assisted Living, and Alzheimer's Care on the Central Coast and Central Valley, California

Dedicated To Serving The Central Coast

San Luis Obispo: (805) 545-5901 · Santa Barbara: (805) 963-6045

San Luis Obispo County
3165 S. Broad Street, Suite #114
San Luis Obispo, CA 93401
805-545-5901
Fax 805- 545-5906
TOLL FREE 888-282-1902
info@seniorlivingconsultants.com

Santa Barbara County
18 W. Micheltorena, Suite #C
Santa Barbara, CA 93101
805- 963-6045
Fax 805-963-6046
TOLL FREE 888-282-1902
info@seniorlivingconsultants.com

Kern County
6900 Valleyview Drive, Suite #133
Bakersfield, CA 93306
661-616-7919
FAX 866-815-2006
TOLL FREE 888-282-1902
info@seniorlivingconsultants.com

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Resident Information

Assistance Needed:	Full Assistance	Some Assistance	No Assistance
Taking Medications
Preparing Meals
Dressing
Shaving, Hair Care
Bathing or Showering
Toileting
Eating

Current Living Situation
Walking Ability
Memory Loss
*Time Frame
Resident Age

Resident First Name
Resident Last Name
Address
Street
City
State
Zip
*Monthly Budget:	Minimum	Maximum

Additional Information:
What circumstances or events have occurred causing you to consider senior housing?

Community Preferences

Care Type Needed:

Assisted Living

Retirement Community

Nursing Home

Alzheimer's Nursing Home

Alzheimer's Assisted Living

Adult Family Home

Home Care

Not Sure

Apartment Size:

Studio

One Bedroom

Two Bedroom

Companion

Amenities & Services:

Community Outings

Full Kitchen

Mini Kitchen

Pets Allowed

Resident Parking

Smoking

Walk-in Shower

Your Contact Information

*First Name

*Last Name

Relation to Resident

*Home Phone

Your Mailing Address

Address
City
State		Zip

Work Phone

Example: 505-555-1212

*E-Mail

*How did you hear about us?

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SAN LUIS OBISPO: (805) 545-5901 · SANTA BARBARA: (805) 963-6045 · TOLL-FREE: (888) 282-1902