DAYTIME Senior Care You Can Trust
New Club Member Forms
Forms
Please read through and complete the following forms, and deliver them to the office or email them to us. We also have printed copies at our office that you can pick up or we can mail to you.
Read through these documents:
Download, complete, and return these forms to AHFTD:
1. Enrollment Application
2. Acknowledgment of Receipt of Participant Documents
3. Physician Letter
4. Release of Authorization of Medical Information
5. Medical Emergency Agreement
6. Participant Service Agreement
7. Data Privacy
8. Photograph Release
9. Social History Intake Needs Assessment
10. Financial Assistance Application
11. Careplan 30-Day Assessment
Schedule A Tour
We are excited to meet you and give you a tour of our facility. You and your loved will be able to ask us any questions and see first-hand if this would be a good fit. Contact us to schedule a 30-minute tour at a time that works for you!
Address:
Located inside
Love of Christ Church (door B)
1971 Pine Cone Road
St. Cloud, MN 56303
Contact:
320-260-7396
info@ahomefortheday.com
Hours:
Mon, Tues, Wed & Fri:
8:30 am - 3 pm
Thursdays & Weekends: Closed