We have private and shared rooms available. Kindly fill out the assessment form below.
INITIAL ASSESSMENT FORM
Marital Status
Married
Single
Widowed
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Where are you currently living?
With Family/Friends
Shelter/Hospital
Homeless
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Are you on any medication?
Yes
No
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Do you have SSI OR SSDI OR Other Sources of Income?
SSI
SSDI
Other
I have work
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Can you live Independently?
Yes
No
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Do you mind shared living space?
Yes, I don't want to share a room
No, I can share a room
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How soon are you needing to move in?
As soon as possible
Within a month
More than a month
Undecided
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