Your First Step The First Step By answering the following three questions, you can take the first step in learning about your senior living options. OK Question Title * 1. What are your areas of concern for yourself or your loved one? Check all that apply. Lack of companionship Safety and Security concerns The need for activity, stimulation & purpose in life Physical health concerns Well-being of spouse/family or primary caregiver Other (please specify) OK Question Title * 2. What do you feel like you or your loved one needs help with? Medication Assistance / Reminders Mobility Bathing, Dressing Incontinence or Toileting Needs Companionship Complications Surrounding Dementia or Alzheimer's Disease Other (please specify) OK Question Title * 3. What considerations do you feel are most important when considering your senior living options? Realizing all are important, please check only your top three considerations. Proximity to Friends / Family Financial Concerns / Community Costs Friendliness of Staff Quality of Food Strength of Activities Program Other (please specify) OK Question Title * 4. Your Contact Information is Required to Provide Feedback on your Options Name * City/Town * State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Email Address * Phone Number OK DONE