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Ricky's Place Care Home - Follow Up Request
In less than 1 minute you will have a follow up set up with us!
6
Questions
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1
What is your Full Name?
*
This field is required.
First Name
Last Name
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2
What is your Email Address?
*
This field is required.
example@example.com
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3
What is your Phone Number?
*
This field is required.
Please enter a valid phone number.
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4
What is your relationship to the potential resident?
Please select your primary reason for contacting us.
Self
Mother/Father
Grandparent
Sibling
Other Relative
Close Friend
Other
Self
Mother/Father
Grandparent
Sibling
Other Relative
Close Friend
Other
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5
What is the Primary Question you have about Ricky's Place?
Please select your primary reason for contacting us.
I have a question about availability.
I have a question about cost.
I have a question about the types of care you offer.
I want to know if you are able to care for someone with a specific medical condition.
I would like to tour your facility.
I am interested in working for your facility.
I am following up on something I have already spoken to you all about.
Other (not listed)
I have a question about availability.
I have a question about cost.
I have a question about the types of care you offer.
I want to know if you are able to care for someone with a specific medical condition.
I would like to tour your facility.
I am interested in working for your facility.
I am following up on something I have already spoken to you all about.
Other (not listed)
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6
Please select an Appointment Time.
*
This field is required.
all initial 30 min consultations are free of charge
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