Hartland Terrace Assisted Living - Comfort. Compassion. Dignity.
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Information Form
First and Last Name
Street Address
City/State/Zip
Contact Number
Looking for
Mother
Father
Other
Payment Option
Private Pay
State Funded
Room Size
Single with full bath
Large single with full bath
Double with full bath
Looking for placement
less than 3 months
3-6 months
6-12 months
over 1 year
Please mail me information
yes
no
Please contact me at my phone
yes
no
Comments or notes
Contact us by phone:
262-369-4391
fax 262-369-4392
By Mail:
327 North Avenue
Hartland, WI 53029
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