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.