Serving Southwest Florida Since 2008
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Full Name:
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Email:
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Phone Number:
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How did you hear about us?
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Internet/Google
Friend
Word of Mouth
Client
Referral
Other
For whom are you inquiring?
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Self/Selves
Friend
Spouse
Client
Parent(s)
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Relative
I'm Looking For...
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CCRC/Life Plan Community
55+ Active Adult Community
Independent Living (Rental)
Skilled Nursing
Assisted Living
Home Health Care
Memory Care
Out of town Placement Assistance
Veteran Benefits
Age-In-Place Services
Affordable Housing (Low-Income)
Medicare/Medicaid Assistance
Employment
Speaking Opportunity
Other
How much research have you done already?
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Just starting
Extensive
Visited a few but nothing serious
Future planning
Approximately, what is your timing?
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Immediate
3 years or more
6 mos. to 1 year
Unsure
1 to 2 years
What size residence might you be interested in?
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One Bdrm/ One Bath
Three Bdrm/ Two Bath
One Bdrm/ Two Bath
Villa/ Single Level Home
Two Bdrm/Two Bath
Other
Two Bdrm/Den/Two Bath
What area of SWFL are you interested in?
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Naples
Cape Coral
Bonita
Lehigh Acres
Estero
Unsure
Fort Myers
Other
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