Apply to EverHeart Senior Living

Ready to take the next step? Complete our application below to begin the admission process. Our team will review it and reach out within 24 hours.

Full Legal Name *

Email *

Address

City

State

Postal Code

Current Living Situation

Emergency Contact Name *

Emergency Contact Phone

Emergency Contact Address *

Relation to Resident

Authorized Decision Maker *

This person is authorized to make decisions on my behalf if I am unable to do so

How did you hear about EverHeart Senior Living? *

Referring Person/Organization Name *

Pharmacy Name *

Phone Number *

Known Allergies *

Can Evacuate Independently *

I am able to evacuate the building with little to no assistance in an emergency.

Can Manage Medications *

I am able to manage my own medications, with or without reminders

Understands Health Assessment *

I understand a brief health assessment is required before a final admission decision is made.

Interested Sliding Scale *

I am interested in being considered for income-based/sliding-scale rent

Eligibility Age 62 *

I am aged 62 or older

Eligibility Shared Living *

I understand EverHeart Senior Living is a shared living community, not a licensed assisted-living or nursing facility.

Eligibility Rent Terms Disclosed *

I understand that rent, fees, and deposit amounts will be provided and explained before I sign the move-in agreement

Preferred Room Type *

Applicant Certification *

I certify that the information provided in this application is true and accurate to the best of my knowledge.

Applicant Signature *

Clear

Date Signed *

By checking this box, you agree to receive calls and text messages from EverHeart Senior Living regarding your inquiry, scheduling a tour, and related updates. These calls may be automated, pre-recorded, or delivered using an AI voice assistant. You also agree to receive marketing and promotional communications from EverHeart Senior Living. Message and data rates may apply, and message frequency may vary. You may opt out of calls or texts at any time by replying "STOP" to any text message or by informing our staff during a call that you wish to be removed from our contact list. Consent is not a condition of receiving services from EverHeart Senior Living.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from EverHeart Senior Living at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

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