Senior Placement Pre-Tour Form

Submission Instructions: Please complete this form thoroughly and click the "Submit" button when you are finished. After submission, you will be directed to a page indicating whether a tour can be scheduled immediately or at a later date. The details you provide will enable us to create a personalized tour experience and showcase services tailored to the prospective resident’s needs and preferences.


Section 1: Prospective Resident Information

Section 2: Health and Care Needs

Please provide details to help us understand the prospective resident’s current health and care requirements. Check each box that applies.


Section 3: Financial Considerations

Understanding budget and payment sources helps us highlight affordable options. Check each box that applies.


Section 4: Lifestyle Preferences and Interests

This section helps us personalize the tour by showcasing relevant amenities and activities. Check each box that applies.


Section 5: Move-In Timeline and Decision Factors

This information helps us prioritize the tour and address key concerns. Check each box that applies.


Key Decision Factors:
What is most important in choosing a community? Check each box that applies and rank the top 3 (1 = highest priority).


Section 6: Additional Information


How Did You Hear About Peters Creek Retirement Community?
Check each box that applies.


Prospective Resident Pre-Tour Referral Form - Acknowledgement

By submitting this referral form, I confirm that the prospective resident and/or their responsible party have given consent to share this information with Peters Creek Retirement Community for the purpose of evaluating senior living options.


Primary Contact Consents to Receive SMS Notifications, Alerts from Peterscreek. Message frequency varies. Message & data rates may apply. Text HELP to 425-600-6960 for assistance. You can reply STOP to unsubscribe at any time.

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