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Family Intake Questionnaire

No family should navigate senior living transitions alone. Whether you are dealing with hospital discharges, urgent assisted living placement, memory care needs, crisis transitions, or caregiver burnout, this intake questionnaire helps us understand your unique situation so we can provide the compassionate guidance you deserves.

Need Immediate Senior Placement Assistance?

Speak With Chris Today!

Chris Ndakwe, Founder & Senior Transition Specialist

972-704-7177 (Call or Text)

chris.ndakwe@yahoo.com

Plano, Texas

We invite you to share your situation with us. Providing the following information helps us prepare for our consultation: family contact details, senior information (current living situation and care requirements), your primary concerns, and preferred timeline for transition.

Family Information

Please provide details for the primary point of contact.

Relationship to Senior
Preferred Contact Method
Phone Call
Email
Text Message
What concerns are you currently facing?

Select all that apply

How soon do you plan to transfer?
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Need Immediate Senior Placement Assistance?

Speak With Chris Today!

Chris Ndakwe, Founder & Senior Transition Specialist

972-704-7177

chris.ndakwe@yahoo.com

Plano, Texas

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