Application Forms
We would like to make your transition to your new home at The Lorelton as smooth as possible. Our application process allows us to gather information that will prepare us to offer the services you will use at The Lorelton. We assure you we will keep your personal information private and will use this information only for the purposes outlined below. You may print our four application forms by clicking on them below. Please don’t hesitate to contact Mary Anne or Ken at The Lorelton to assist you with completion of these forms.
The Lorelton Application
Please complete and sign this form to give us an idea of your needs and the services you plan to use at The Lorelton.
Financial Application
Please complete and sign this form. When completing the form, you do not need to reference specific account numbers. When we receive this form your financial information will be analyzed and we will provide feedback concerning the apartment size you may wish to choose and any possible need to supplement your funding in the future. As a non-profit organization dedicated to offering quality affordable services to our residents, it’s important for us to have this discussion before you move in.
Medical Application
Please sign this form and submit it to your primary care physician for completion. This form must be completed within 30 days before your move-in date. Depending on your physician, you may need to make an appointment for him/her to complete the form. We recommend you submit this form to your physician as quickly as possible to expedite your move to The Lorelton. Once we have received this form our Director of Nursing will schedule a visit with you, usually in your home environment, to complete a required assessment of your needs. She will discuss all aspects of our care during her assessment and will use this information to arrange any and all care you may require at The Lorelton.
Information Sheet
Please complete this form which gives us information for emergency contacts, insurance information, your physician contacts, and any legal arrangements you may have made. We will type this form and it will be kept with your medical record at The Lorelton. This information is used by our staff for proper contacts to arrange your care, and is also used in an emergency situation to contact the proper individuals and communicate your billing information to the hospital that will be caring for you.