Please provide the following information so that we may better serve you find the right facility for your loved one. This information assists us in providing you several options that meet you and your loved ones needs. For immediate assistance, please call us at 858-581-6400
What is your age or the age of your loved one?
What is your desired price range?*
(Check all that apply)
SSI - $999
$1000 - $1999
$2000 - $2999
$3000 - $3999
$4000- $6000 *If your loved one has a diagnosis of dementia this may increase the cost.
What type of room are you looking for? (Check all that apply)
Private room
Female Semi-private
Male Semi-private
What size of facility would you or your loved one prefer?
Any size
Small 6 room family home setting
Medium size facility
Large facility
Facility with continuum of care
Ability to transfer from chair to standing
No Problem
Some Assistance
Maximum Assistance
Health Status
Continent
Incontinent
Diabetes?
No
Yes
Pills
Insulin
Special Diet
Mental Status
Alert
Short-term memory loss
Alzheimer's
Wanders
Do you or your loved one plan on bringing a pet?
None
Cat
Dog
Other
When do you or your loved one expect to move in?
ASAP
1 - 2 weeks
2 - 4 weeks
Not sure
I only want to consider facilities within:
No limit
5 miles
10 miles
15 miles
What areas would you like to consider? (Check all that apply.) San Diego County: North County
Central
East County
South Bay
Please provide other relevant facts:
Loved One's Name:
Person Submitting:
Current Address:
Phone:
Mobile:
Email Address:
Phone Number:
Preferred way to contact:
Area of San Diego:
Age/DOB:
Description:
We will be contacting you within 48 hours to provide you with facility information. Please contact us directly if you need information before this timeframe. For immediate assistance, please call us at 858-581-6400
Lifeline Healthcare's placement service is free to the elderly and their families in San Diego. Lifeline Healthcare makes their money on this service through referral fees paid by facilities. We provide unbiased recommendations based on the needs of your loved one. We ask that if you utilize our service you allow us to make initial contact with the Assisted Living or Board and Care so that we may qualify for our referral fee. Lifeline Healthcare provides placement service to Assisted Living and Board and Care facilities free of charge. If you need assistance locating a Skilled Nursing Facilities we are able to do that for an hourly charge.
