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Programs

Application for Services

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Applying for Services

Thank you for your interest in our Day Care and/or Respite program.

The foundation of our program is "commitment". We are committed to giving our clients quality care and committed to supporting their care givers. Therefore, we are always available to answer any additional questions you may have about our program. Please do not hesitate to contact us at the above telephone number, during normal business hours.

Person(s) desiring participation in our program should complete our Client Information Form (pdf), and Medical Examination Form (pdf)   and submit to our center. Both can be viewed and printed on-line by clicking on the corresponding form that is highlighted on this page.

The Medical Examination Form (pdf) must be completed by the patient's primary care physician.  Once completed, return the forms to our center at the above address either personally or by U.S. mail.

Our Patient Care Coordinator will contact you regarding program participation and any applicable financial arrangements.