Thank you for expressing an interest in the Adult Day Center. Our program is designed to provide a meaningful day for those who attend the center, offering positive interactions, stimulation as well as fun and interesting activities while at the same time offering some respite to you as a caregiver. Enclosed please find a physician form, a cost share application, and a pre-admission form.

The physician form should be filled out in its entirety by the physician who provides care to your family member who will attend The Center. This includes a diagnosis of dementia, and a current TB test (skin test) or a negative chest x-ray that has been done within the past year. The completed physician form can be faxed to the number at the bottom of the physician form.

Please complete the cost share application, making sure to sign and date the back of the form. Additionally, please complete the pre-admission form. As soon as all the completed forms have been returned to us, we will call to set up an intake appointment. The intake appointment is usually scheduled around 11:45 a.m., includes lunch for your family member who would attend the Center, and takes about one to one and a half hours to complete.

Pre-Admission Paperwork
Help • Compassion • Hope