Questionnaire For HSCL Wait-List
Please complete form to submit to wait list committee. You will be notified after review process.
Name of Prospective Resident
Contact Phone Number
Contact Address- used only for wait list purposes.
How did you hear about us
Current Cedar Sinai Park Resident
Jewish Community Member
If other please explain
Desired Move-In Time
6 Months to 1 Year
1 Year to 2 Years
What is the age of the prospective resident?
Briefly Describe Care Needs
Payment Type- Upon admission, what payer source can you anticipate?
Long Term Care insurance
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