Fallbrook woods

		HOME

		ASSISTED LIVING

		SECURED UNIT

		ALZHEIMER'S

		RESPITE CARE

		ADMISSIONS

		VIRTUAL TOURS

Library
Main Dining Room
Residents Room
Court Yard
Piano Room

		ACTIVITIES

		EMPLOYMENT

		DINING

		DIRECTIONS

		CONTACT US

Admissions

If you are interested in learning more, please contact Denise Feeney at 207-878-0788, option 1. If it is after 4:30pm, please feel free to call her on her cell phone at 207-831-3726. You may also use the form below to send her an email, and she will get back to you as soon as possible.

Applicant's Name *	Resident's Name *		Resident's Birthdate *


Address *		Phone Number *		Marital Status



What Are You Looking For *			Payment Options *
Residential care Memory impairment Respite			Privately funded Long term care insurance MaineCare (Medicaid)

Present Living Condition			Does the Resident Have
In own home Apartment Subsidized Boarding Hospital Relatives Other:			Guardianship Healthcare power of attorney Conservator Living will Manages own affairs Financial power of attorney

Emergency Contact
Name	Relationship to Resident		Address	Telephone


Family Members
Name	Relationship to Resident		Address	Telephone




Primary Physician
Name		Address		Telephone


Other Physician
Name		Address		Telephone


Dentist
Name		Address		Telephone


Ophthalmologist
Name		Address		Telephone


Health Devices
Glasses Hearing aid	Dentures Cane	Walker Wheelchair	Other

Funeral Director
Name		Address		Telephone


Religion, Place of Worship


How Did You Hear About Fallbrook Woods *