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PSL - Photo Submission Form
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Housekeeping such as laundry and linen changes made for you
Yard work and maintenance provided all year round
Transportation services provided like running errands or doctor’s appointments
Fun activities with other seniors such as happy hours, exercise classes, walking groups, and recreational clubs like reading, gardening, or drawing
Scratch-made chef-inspired dining with snacks and beverages throughout the day
Minimal assistive services provided as needed
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Cordata Court, Bellingham, WA
Greenhaven Place, CA
Pegasus Landing of Chisholm Trail, Keene, TX
Ridgmar Place, Fort Worth, TX
South Hill Village, Spokane, WA
The Courtyards at Mountain View, CO
Town Village Crossing, Arlington, TX
Town Village of Leawood, Leawood, KS
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Have they lost/gained weight recently?
Have they been taking their medications on time?
Has their grooming or hygiene changed?
Have they isolated themselves or do they lack social engagement with others?
Are there issues with mobility or access to medical care?
Name
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Bridgewood Gardens, Albertville, AL
Pegasus Landing of Mesa, Mesa, AZ
Castlewoods Place, Brandon, MS
Cordata Court, Bellingham, WA
Creston Village, CA
Dunwoody Place, Atlanta, GA
Evergreen Place, Brockport, NY
Gig Harbor Court, Gig Harbor, WA
Greenhaven Place, CA
Historic Roswell Place, Roswell, GA
Laketown Village, Kenner, LA
Magnolia Place of Roswell, Roswell, GA
North Point Village, Spokane, WA
Parmer Woods at North Austin, Austin TX
Pegasus Landing of Forney, Forney, TX
Pegasus Landing of Overland Park, Overland Park, KS
Ridgeland Place, Ridgeland, MS
South Hill Village, Spokane, WA
Sun City West Assisted Living, Sun City West, AZ
The Chateau at Gardnerville, Gardnerville, NV
The Courtyards at Mountain View, CO
Pegasus Landing of Tanglewood, Houston, TX
The Gardens at Marysville, Marysville, WA
The Havens at Antelope Valley, CA
The Landing at Queensbury, Queensbury, NY
The Legacy at Cimarron, El Paso, TX
The Legacy at Crystal Falls, Leander, TX
The Legacy at Falcon Point, Katy, TX
The Legacy at Forest Ridge, Schertz, TX
The Legacy at Long Meadow, Richmond, TX
The Legacy at Santa Fe, NM
The Legacy at South Plains, Lubbock, TX
The Legacy at Town Square, Amarillo, TX
The Oaks at Inglewood, CA
The Renaissance of Florence, Florence, AL
The Rivers at Puyallup, Puyallup, WA
The Seasons of Reno, Reno, NV
The Village at Rancho Solano, CA
Tucson Place at Ventana Canyon, Tucson, AZ
Whispering Winds of Apple Valley, CA
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Check off the questions that apply to your loved one:
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Choices
Have your loved one lost/gained weight recently?
Have they been taking their medications on time?
Have they gotten lost in an area that is normally familiar to them?
Do they have trouble reciting their address and/or phone number?
Can they perform personal care duties (grooming and hygiene)?
Have they isolated themselves or do they lack social engagement with others?
Are there issues with mobility or access to medical care?
Has their personality changed?
Are your care-taking duties adversely affecting your own life and daily activities?
Name
*
First
Last
Phone
*
Email
*
Preferred Contact Method
*
Phone
Email
Select a Community
*
Select a Community
Bridgewood Gardens, Albertville, AL
Pegasus Landing of Mesa, Mesa, AZ
Castlewoods Place, Brandon, MS
Cordata Court, Bellingham, WA
Creston Village, CA
Evergreen Place, Brockport, NY
Gig Harbor Court, Gig Harbor, WA
Historic Roswell Place, Roswell, GA
Laketown Village, Kenner, LA
Magnolia Place of Roswell, Roswell, GA
North Point Village, Spokane, WA
Parmer Woods at North Austin, Austin TX
Pegasus Landing of Chisholm Trail, Keene, TX
Pegasus Landing of Forney, Forney, TX
Pegasus Landing of Overland Park, Overland Park, KS
Ridgeland Place, Ridgeland, MS
South Hill Village, Spokane, WA
Sun City West Assisted Living, Sun City West, AZ
The Chateau at Gardnerville, Gardnerville, NV
The Courtyards at Mountain View, CO
Pegasus Landing of Tanglewood, Houston, TX
The Gardens at Marysville, Marysville, WA
The Havens at Antelope Valley, CA
The Landing at Queensbury, Queensbury, NY
The Legacy at Cimarron, El Paso, TX
The Legacy at Crystal Falls, Leander, TX
The Legacy at Falcon Point, Katy, TX
The Legacy at Forest Ridge, Schertz, TX
The Legacy at Long Meadow, Richmond, TX
The Legacy at Santa Fe, NM
The Legacy at South Plains, Lubbock, TX
The Legacy at Town Square, Amarillo, TX
The Rivers at Puyallup, Puyallup, WA
The Seasons of Reno, Reno, NV
The Village at Rancho Solano, CA
Tucson Place at Ventana Canyon, Tucson, AZ
Whispering Winds of Apple Valley, CA
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