assisted independent living retirement communities arizona
 

A Free Lunch - absolutely there is such a thing! Simply take a moment to tell us about yourself or a family member interested in Sierra Pointe. We will arrange a free lunch for you at the Pinnacle Restaurant, our marquis Dining Room.
  Contact Information
First Name
Last Name
Email
Phone -
Best Time to Call
This Survey is For Myself   A Family Member

Survey Questions

1. How well are you able to perform basic domestic duties?

I am able to safely perform various domestic duties such as housekeeping and laundry.
I need occasional assistance with domestic duties.
I need frequent assistance with domestic duties.
Not certain.

2. Presently, how mobile are you?

I walk relatively independently with minimal assistance or use cane, walker or wheelchair
     independently.
I need occasional help with assistive device and/or light physical assistance.
I always need assistive device and/or light physical assistance.
Not certain.

3. How well do you manage the daily task of dressing?

I am able to put on and remove all clothing.
I need occasional help with dressing.
I always need help with dressing.
Not certain.

4. How well do you manage daily grooming?

I am able to bathe or shower safely and independently.
I occasionally need some assistance getting in/out of tub or shower.
I always need assistance getting in/out of tub or shower.
Not certain.

5. How do you manage your daily nutrition?

I am able to shop, prepare and maintain a healthy, balanced diet.
I need some assistance with shopping and meal preparation.
I always need assistance with meal preparation and maintaining a healthy diet.
Not certain.

6. How do you manage you medication?

I take no medications or I am able to self-medicate without reminders or assistance.
I need reminders to take medications.
I require injections regularly due to diabetes or other condition.
Not certain.

7. How would you describe your  psychological or mental well being?

I am stable, well-adjusted and conduct myself appropriately.
I am often depressed, confused and/or suffer anxiety.
I occasionally agitated by others.
Not certain.

8. How good is your memory?

I have no trouble with person, place or time orientation.
I experience occasional memory loss.
I experience persistent memory loss.
Not certain.

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14500 N. Frank Lloyd Wright Blvd. Scottsdale, Arizona 85260

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