Questionnaire For HSCL Wait-List
Please complete form to submit to wait list committee. You will be notified after review process.
Name of Perspective Resident
Your answer
Contact Name
Your answer
Contact Phone Number
Your answer
Contact Email
Your answer
How did you hear about us
If other please explain
Your answer
Desired Move-In Time
What is the age of the perspective resident?
Your answer
Describe Care Needs
Your answer
Upon admission to Harold Schnitzer Center for Living, which payer type can you anticipate?

Payment Type
Describe
Your answer
Describe Cedar Sinai Park Involvement, if any
Your answer
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