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Digital Connection Card
fill out our digital connection card to stay connected
8
Questions
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1
Date
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Date
Year
Month
Day
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2
Name
First Name
Last Name
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3
Email
We'd love to reach out to you and and keep you in our phone directory
example@example.com
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4
Phone Number
We'd love to reach out to you and and keep you in our phone directory
Area Code
Phone Number
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5
Are you on social media?
Check the ones that apply to you
facebook
instagram
twitter
Other
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6
Would you like to be contacted by the staff at Hillside?
YES
NO
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7
If you would like to be contacted please indicate the preferred method of contact
Click how you would like us to contact you
Phone Call
Text Message
Email
Facebook
Instagram
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8
Would you like to be added to our email newsletter to keep in touch?
YES
NO
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