Complete the form below Please complete the following form in its entirety by typing information into the proper field Facility Capabilities Checklist Facility Name(Required)Please indicate what services your facility currently offers:Please indicate which services are offered at your facility(Required)Check all that apply Physical Therapy Occupational Therapy Speech Language & Dysphagia Therapy Wound Care IV Therapy Orthopedic & Neurological Rehabilitation Stroke Recovery Cardiopulmonary Recovery Dementia/Alzheimer's Care Ostomy Care Hemodialysis support Labs, X-rays, other medical testing in house Select Allsection b On-site Peritoneal Dialysis Secure Memory Care Pain Management unit Psychiatric services Program Tube Feedings Hospice & Palliative Care Hygiene support/toileting Respite Care Transportation services Long-term housing Short-term housing Assisted Living Dietary Program 24/7 access to staff nurse 24/7 access to staff physician Select Allsection c Assisted Living Dietary Program 24/7 access to staff nurse 24/7 access to staff physician Social services/social worker Comfortable staff to patient ratio Continued education for staff available Select Allsection d Ophthalmology/Vision care Podiatry Chiropractor Massage Therapy Dentistry Other Mental health services Gerontology Dermatology Audiology In house pharmacy Medication management Select AllWhat Amenities does your facility offer?(Required)Check all that apply Renovated property Private rooms/semi-private rooms Accessible showers Housekeeping services Free internet & WIFI Cable access included Game room/on-site entertainment Library Beauty & barber services Religious services Select AllWhat Amenities does your facility offer?(Required) Pet-friendly Walking trails Daily activities Arts & crafts Aerobics/exercise Musical & cultural experiences Regular outings into the community Gardening Landscaped property Swimming pool Select AllAny other services or amenities not listed above?Do you have any awards, certifications or other distinctions?Please list insurances accepted(Required)Optional: Do you know any details about the founding of your center? Any historical context you can provide on the origins of the facility.Please summarize below or attached documents for reference in the uploads section. File uploadMax. file size: 256 MB.Please add any files for reference of the information provided above as applicable (logos, documentation, etc.)CommentsThis field is for validation purposes and should be left unchanged.