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Submit our 2-page preliminary application form below OR 
download the PDF version and mail to our office, attn: Resident Application

P.O. Box 652

Damariscotta, ME 04543

(207) 563-2148

Fax (207) 563-2149

ELDERCARE NETWORK OF LINCOLN COUNTY

Residency Application

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Personal Information

Birthday
Month
Day
Year
Marital Status
Single
Widowed
Married
Divorced
Current Living Arrangement

Preference

Desired Location

Insurance

Health Information

Level of mobility (single-floor)
Independent
Wheelchair
Walker
Cane
Other
Can applicant navigate stairs comfortably?
Yes
No
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