Hallmark Assisted Living

Lic. #155801264

(661) 834-0200
Call today or stop by
for more information

Start Looking

Below is our assessment form which will allow us to search for the best care facilities for your individual needs. Once we receive your information we will contact you to confirm receipt. We will discuss your unique needs and we will begin assessing your needs. Finally, we will take you on a tour of facilities and provide assistance for an appropriate placement.

*Please Note: Unlike other facilities we WILL NOT share this information with any group, company or individual. This information is solely used to provide you with better service and is considered CONFIDENTIAL and for internal use only by Hallmark Assisted Living.

Instructions: Please fill out form completely and submit.

Name: Resident Name:
City:   Target Cities:
Phone:   Resident Age:
Email:   Resident Sex: Male Female

Alzheimer's Dementia Diabetes Incontinent
Non-Amb   Wandering   Aggression   Oxygen

  Please enter the five digit number
in the image in the space provided.