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Tell us a bit more about your needs so we may offer the best resources to help you. Please complete only the amount of information you feel comfortable sharing. We will follow up with you by phone or email (whichever you prefer).

Inquiring for:

Self
Friend
Relative

If other than you, what is the name and age of person needing assistance?

I would like extra copies of the guide sent to me for the region selected below:

Portland
Vancouver
Salem

I would like more information about:

Care & Health Services

Adult Day Programs
Ambulatory Aids
Care Management
Emergency Response Systems
Health Insurance/Medicare
Home Health/In Home Care
Hospice
Medical Equipment Supply
Prescription Assistance
Rehabilitation/Therapy
Respite Care

Housing

Assisted Living/Residential Care
Memory Care
Independent Living
Nursing Home

Professional Services

Elder Law/Estate Planning
Moving/Real Estate Services
Financial Planning
Reverse Mortgages
Long-Term Care Insurance

Additional Information

When do you expect to need housing, service(s) or product(s)?

Now
Within 6 months
6 to 12 months
Later

What type of funding will you use to pay for services?

Private Pay
Medicare
Medicaid or Public Assistance
Health Insurance
Long Term Care Insurance
Veteran Benefits



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