Senior Solutions of Michigan L.L.C. 143 Cadycentre, #221 Northville, MI 48167 Margie Mackson (248) 444-9590 Carolyn MacMillan (248) 763-6319 Contact us at info@seniorsolutionsmi.com Home About Us Senior Housing Solutions Senior Care Management Providers Monthly Feature Contact Senior Housing Solutions Senior housing solutions is a free referral service that helps assist families to identify the right type of senior housing needs. Senior housing solutions will assist families with the different types of housing including independent, assisted living w/ services, Alzheimers (memory-supportive care), adult foster care, or skilled care nursing homes. Our senior living specialists are highly trained and educated at providing the best continuum of care facilities for seniors. Please fill out this form to the best of your ability. After this form is received by a senior living specialist, you will be contacted. Your privacy is important to us. Any information you provide will be held in strictest confidence. We WILL NOT use any information on this form except as required to respond to your request. *Upon request a full comprehensive assessment & evaluation is available for an additional fee. Your Contact Information Your first name:  Your last name:  Address:  City:  State:  Zip:  Home phone:  Business phone:  Cell phone:  Fax:  E-mail:  Best way to contact you?:  home phone business phone cell phone fax email Seeking assistance for:  mother father grandparent other Senior's information Senior's first name:  Senior's last name:  Senior's gender:  male     female Senior's age:  Senior's date of birth:  if your are seeking housing solutions for a couple rather than a single person, please enter the other senior's information below. Senior's first name:  Senior's last name:  Senior's gender:  male     female Senior's age:  Senior's date of birth:  Current living arrangments: at home with family member care facility out of state other If presently living at a care facility, please enter facility name:  Please enter current and past diagnosis: Current activities of daily living care Independent bathing dressing Grooming Medication setup and administration incontinence (bowel or bladder) toileting walking independently walking with assistant devices injections catheter colostomy feeding What type of facility are you looking for? Retirement Home Assisted Living Board and Care Skilled Nursing Alzheimers and Dementia Locked Facility Respite Care Do you have a room preference? Private Shared Studio One bedroom Two bedroom What is the monthly budget? $900-$1200 $1300-$1800 $1900-$2500 $2600-$3500 $3600-$5000 S.S.I. Other Please enter your desired location: How soon do you need placement? Immediately 1-3 months 6-12 months Additional information or comments: