Intake form

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Name

Email address

seeking address the

Please specify any medical conditions that we should be aware of.

What medications is the patient currently taking?

What is the preferred communication method?

Are there any dietary restrictions or preferences?

What is the patient's mobility level?

Please list any hobbies or interests that the patient enjoys.

What is the expected duration of care needed?

Is there a preferred move-in date?

Which service or services are you interested in?

Customized care plans
Luxury living environment
24/7 compassionate support

Additional questions or comments

About Us

At Stars AFH LLC, we specialize in providing seniors with personalized care in a warm, home-like environment. Located in the heart of Centralia, Washington, and serving Lewis County, we are dedicated to supporting the physical, emotional, and social well-being of our residents.