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Please complete the information below and click on the "submit" button to receive your free introductory brochure. Thank you for your interest in Willow Valley Retirement Communities.

Name(s):

Address:

City:

State:

Zip:

Telephone:

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Age(s):

Marital Status:

1.) Are you actively considering a move?
Yes, moving within one year
Yes, moving within 1-2 years
Yes, planning for a future move
No, gathering information for myself
No, gathering information for a family member or friend

2.) Have you visited a Continuing Care Retirement Community (CCRC) for an appointment and tour?
Yes
No

3.) Please tell us the names of the CCRC's you have visited and their (city & state) location.
1)
2)
3)

4.) What type of Residence are you considering moving into?
Apartment
Villa/Townhome/Cottage

5.) What size home would you choose?
Studio/One Bath
One Bedroom/One Bath
Two Bedroom/One Bath
Two Bedroom/Two Bath
Two Bedroom with Den/Two Bath
Large

6.) What are your primary reasons for considering moving to a Continuing Care Retirement Community (CCRC)?
To be near family
Health reasons
House a burden/want less maintenance
Security
Don't want my children/family to have to worry about my long-term care needs

7.) How did you first learn about Willow Valley Retirement Communities?

Magazine advertising	Magazine Name:
Newspaper advertising	Newspaper Name:
Referred by family or friend
Internet Search Engine
Willow Valley mailing
Other

Comments:

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600 Willow Valley Square, Lancaster, PA 17602 800-770-5445 or 717-464-6800 Contact Us