Response Form

Northland Lutheran Retirement Community, Inc.
Response Form

	You may use this form to receive information from Northland regarding your needs or questions or you can e-mail us at: lutherhome@webcntrl.com
	Are you inquiring for yourself or another? Self Another Which of Northland's services are you interested in receiving information about? Check as many as apply. HOUSING & SKILLED CARE SERVICES Northland Terrace Estates Northland Homes Northland Home Health Luther Home Luther Manor Northland Village Edgewood Manor Interfaith Manor (Menominee, Michigan) Newhope Horizons (Menominee, Michigan) Luther Haven (Alzheimer's care) OTHER SERVICES Personal Response system Mobile Meals Outpatient Rehabilitation Northland Foundation Transportation Services Volunteer Opportunities WHERE WOULD LIKE THIS INFORMATION SENT? Your Name Address City ZIP Phone (include area code) Email Address: (e.g. you@address.com) WOULD YOU LIKE A PERSONAL CONTACT BY A REPRESENTATIVE OF NORTHLAND RETIREMENT COMMUNITY? Yes No, thank you. YOUR QUESTIONS OR COMMENTS ARE WELCOMED Confirm that the information you entered is correct. If not, re-enter your choices. When completed, press the "submit" button once. Thank you.