MEMBERSHIP

The following benefit from membership in The Retreat:

  • Adults who suffer from chronic illnesses such as:
    • Hypertension/High Blood Pressure
    • Cardiovascular Disease
    • Diabetes
    • Depression
    • Stroke
    • Parkinson’s Disease
    • Cancer
    • Traumatic Brain Injury
  • Those who have completed a course of inpatient rehabilitation but continue to require ongoing therapeutic and exercise programs for optimal recovery
  • Frail elders needing a safe environment with professional support to prevent falls
  • People who are isolated at home and would experience improvement in the social environment
  • Families and care partners who require respite for personal emotional and physical soundness

Please Fill out the Membership Application and submit:

MEMBER APPLICATION for THE RETREAT

MEMBER INFORMATION

EMERGENCY CONTACT 1

Name of a family member or friend who is responsible for you and can be contacted in an emergency:

EMERGENCY CONTACT 2

Name of a family member or friend who is responsible for you and can be contacted in an emergency:

MEDICAL PROVIDER

ATTENDANCE AND TRANSPORTATION

PERSONAL CONCERNS AND KNOWLEDGE

Care Partner(s), please share any personal concerns/knowledge you have that might have an impact on the member's care plan:

SIGNATURE