Application

We require proof that the resident has available assets that will allow him/her to stay at CCNRC Family of Care (HomePlace) Assisted Living for at least one year. Please provide bank statements showing savings accounts, checking accounts, CDs, stocks, bonds, etc. that will verify this financial ability.

I agree that if I am accepted as a resident of Sagepoint Family of Care (HomePlace) Assisted Living:

1. I recognize my financial obligation to pay all doctors fees, hospitalization charges, private duty nursing, and medication charges that I may require that are not covered by government or private insurance.
2. I will pay monthly, in advance, any charges for which I am responsible.

I hereby certify that all the above information and attached statements are accurate and correctly reflect the financial position of the resident.

We require proof that the resident has available assets that will allow him/her to stay at Sagepoint Family of Care (Abbey Manor) Assisted Living for at least one year. Please provide bank statements showing savings accounts, checking accounts, CDs, stocks, bonds, etc. that will verify this financial ability.

I agree that if I am accepted as a resident of Sagepoint Family of Care (Abbey Manor) Assisted Living:

1. I recognize my financial obligation to pay all doctors fees, hospitalization charges, private duty nursing, and medication charges that I may require that are not covered by government or private insurance
2. I will pay monthly, in advance, any charges for which I am responsible.

I hereby certify that all the above information and attached statements are accurate and correctly reflect the financial position of the resident.