Page 21 - Triad Senior Living Guide Spring 2017
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INDEPENDENT LIVING        21












                                 q  YES! I am interested in the following types of
                                    housing arrangements, products or services for
                                    myself or a family member.
                                 q  YES! I would like to receive a FREE copy of the next
                                    SENIOR LIVING GUIDE edition.
     Communities            Services                q  End of Life Planning/Funeral
     q  Active/Independent  q  Legal/Financial Guidance  q  Real Estate/Moving Services
     q  Assisted Living     q  Adult Day Care       q  Legal/Financial Guidance
     q  Rehab/Skilled Nursing  q  Hospice/Palliative Care  q  Home Health/
     q  Alzheimer’s/Memory Care  q  Medical Equip/Supplies  Companion Care
                            q  Hospitals/Physician Care
     I am most interested in this general area:  q South Carolina–Statewide
     q North Carolina:                  q Virginia:
       q  Piedmont NC - Charlotte Metro &      q Hampton Roads
          Surrounding Counties          q  Florida:
       q  Triad NC - Greensboro/Winston-     q Central   q South   q West Coast
          Salem/High Point
       q  Triangle NC - Raleigh/Durham/Chapel Hill
     Name ____________________________________________________________

     Address ___________________________________________________________
     City  _______________________________________ State ____ Zip ___________
     Best phone number where you may be reached ___________________________________
     Email ____________________________________________________________
     Pet(s) name _____________________________________ I am a veteran q Yes  q No
     I am looking for information for  q Myself  q My parent  q A relative  q A friend
     Your age group (optional)  q under 50  q 50–59  q 60–69  q 70–79  q 80+
     I plan on making a decision in  q 1–3 months  q 3–6 months  q 6–12 months  q over 1 year
     I obtained my copy of Senior Living Guide at  ____________________________________
                 For information on communities nationwide visit www.seniorlivingguide.com
                  For an online version of our books visit www.seniorlivingguide/ebooks
                To mail this in to receive a free copy of any of our books send to:
              Fairfax Publishing Company PO BOX 6327 High Point, NC 27262-6327
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