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Who are you considering The Regency for?
-----------My ParentMy SpouseMyselfOther Family Member

What is the potential resident's current living arrangement?
-----------Lives in home independently (No care services)Lives in home with some assistanceLives in a community for independent seniorsLives in an assisted living communityLives in a nursing and rehabilitative facilityLives in someone else's home (family member or friend)

When do you or your loved one plan to move into senior living?
-----------Within 1 Month1-3 Months3-6 Months6+ Months

How did you hear about us?
-----------Friends or FamilyProfessional (Doctor, Social Worker, etc.)InternetBuildings/SignsDirect MailOther

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