The Brook Retirement Communities

Independent Living and Assisted Living

CORPORATE OFFICES

PHONE (989) 745-6500

FAX (989) 745-6505

ADDRESS 2375 South I-75 Business Loop, Suite 4, Grayling, MI 49738

BUSINESS HOURS Monday – Friday 8:00am – 5:00pm

INQUIRY

Have a question or comment? Please fill out our form and we will promptly reply back to you within 24 business hours or sooner.

Contact Brook Retirement

Name *

Phone *

Email *

Street Address

City

State

Postal Code

How Should We Contact You?

Best Time to Contact You?

Community Location *

Your Relationship To Person You Are Inquiring For *

What Type of Stay Are You Interested In? *

How Did You Hear About Us? *

Additional Comments or Requests?

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APPLICATION FOR ADMISSION

Are you ready to join the Brook Family? Fill out our application for admission to get the process started. If you have any questions, or need help with the form, please call us at (989) 745-6500

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Application For Admission

Date *

PERSONAL INFORMATION

Full Name *

Date Of Birth *

Street Address *

City *

State *

Zipcode *

Phone *

Are You Currently in an Independent / Assisted Living Facility? *

If YES, Please List Name and Address of Facility

PERSONAL PHYSICIAN / PROVIDER

Name of Physician

Physician Specialty or Type

Phone

Street Address

City

State

Zipcode

PERSONAL PHYSICIAN / PROVIDER 2

Name of Physician

Physician Specialty or Type

Phone

Street Address

City

State

Zipcode

RELATIVES: (Spouse first, if applicable, then children and other relatives)

Full Name (Relative 1)

Relationship

Age

Street Address

City

State

Zipcode

Phone (Home or Mobile)

Phone (Work)

Full Name (Relative 2)

Relationship

Age

Street Address

City

State

Zipcode

Phone (Home or Mobile)

Phone (Work)

Full Name (Relative 3)

Relationship

Age

Street Address

City

State

Zipcode

Phone (Home or Mobile)

Phone (Work)

Full Name (Relative 4)

Relationship

Age

Street Address

City

State

Zipcode

Phone (Home or Mobile)

Phone (Work)

POWER OF ATTORNEY / WILL INFORMATION

Do You Have an Power of Attorney or Guardian? *

If YES, Please list Name, Address and Phone Number

Do You Have a Living Will? *

BILLING INFORMATION

Please Bill Me

AT MY BROOK ADDRESS

PLEASE SEND BILL TO ANOTHER ADDRESS

Name

Street Address

City

State

Zipcode

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Our purpose is clear.
Our performance is consistent.
Our passion is people.

The Brook Retirement Communities

CORPORATE OFFICES

INQUIRY

APPLICATION FOR ADMISSION

LIVING AT THE BROOK

RESOURCES

CORPORATE

FOLLOW US

LIVING AT THE BROOK

RESOURCES

CORPORATE

FOLLOW US