Our 7 Health Care Center Locations

• NORTHEAST GEORGIA
  • ClevelandFriendship Health & Rehab
  • ClevelandGateway Health & Rehab
• NORTHWEST GEORGIA
  • RomeChulio Hills Health & Rehab
  • RomeFifth Avenue Health Care
  • TrentonDade Health & Rehab
  • CedartownCedar Springs Health & Rehab
• METRO ATLANTA
  • AtlantaReliable Health & Rehab at Lakewood

Form

1. Which Reliable Health Care Center are you interested? *Required
2. Friendship Health & Rehab, Cleveland Gateway Health & Rehab, Cleveland Chulio Hills Health & Rehab, Rome Fifth Avenue Health Care, Rome Dade Health & Rehab, Trenton Cedar Springs Health & Rehab, Cedartown Reliable Health & Rehab at Lakewood, Atlanta
3. Your name
4. Potential resident's name
5. Please detail the potential resident's needs, so we can understand how to provide the right care.
6. What other factors do we need to know about?
7. What is the potential resident's age?
8. Is this your:
9. Mother
   Father
   Husband
   Wife
   Sister
   Brother
   Other relationship
   
10. Are they covered by:
11. Medicare
    Insurance
    Other form of payment
12. Where is the potential resident now?
13. When do you need us to be ready?
14. 1-2 days
    3-7 days
    1-2 weeks
    3-4 weeks
    more
    
15. Who do we need to contact (Doctor, Hospital, etc.)?
16. What else do you need us to know?
17. How should we contact you? *Required

 

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