1(403)-625-3988

Porcupine hills lodge

seniors housing in Claresholm, Alberta

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Apply to become a PHL resident

Application for Accommodation


Application 

We will need information regarding the individual who would like to be apart of the PHL family.


Please fill out the following questions.

Current Housing - Do you live alone? *
Does your home meet your needs? *
Do you have family/friends living near by who are willing to provide support if necessary? *
Name/Address/Phone/Relationship Who you authorize to have your personal and medical information.
Medication Assistance is not provided by The Porcupine Hills Lodge; therefore, are you prepared to administer your own medication or have you arranged with a family member to do so?
Personal Assistance - *
Personal assistance with activities of daily living is not provided at the Porcupine Hills Lodge. Are you willing to accept a move to another facility should you require this assistance?
SUBMIT
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