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Residency Application

Submit our 2-page form below OR 
download the PDF version and mail to:

 

Resident Application

ElderCare Network of Lincoln County

P.O. Box 652

Damariscotta, ME 04543

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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