Assisted Living
Evaluate & Choose
The following is a questionnaire of services, amenitites and accommodations
for senior residences. Making the right choice is easier when you thoroughly
evaluate each residence using these criteria. Not all questions will be relevant
to your particular situation based on whether an independent or assisted living
residence is being chosen. Every residence is unique. We recommend making
several visits, at various times of day, to each residence you are considering.
Fill in the information below for each residence you visit. On the following pages, circle Y or N
for each question. This worksheet will give you a direct comparision for three residences.
1
2
Residence: _____________________________________________________ ____________________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
______________________________________________________________________________
__________________________________________________________________
Residence: _____________________________________________________ ____________________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
______________________________________________________________________________
__________________________________________________________________
Residence: _____________________________________________________ ____________________
Address: _________________________________________________________________________________
Administrator: ______________________________ ____________________________
____________________________________ _____________________________
______________________________________________________________________________
__________________________________________________________________
3
“QUESTIONS TO ASK” WORKSHEET
www.PolkElderCare.com 21
/www.PolkElderCare.com