Shonna Bisagno
Licensed REALTOR®
208-914-8565
sbisagno@kw.com
Evaluation Form
☐ Independent Living ☐ Assisted Living ☐ Memory Care
(Fill out a separate form for each level of care.)
☐ Skilled Nursing
☐ 55+ Community
Evaluation Date: _______________________________________
Community Name: _________________________________________________________________________________________
Current Waitlist Time: ___________________________________
Down Payment Amount: ___________________________
Monthly Charge (one person): _____________________________
Monthly Charge (couple): __________________________
Apartment Information:
Sizes (sq ft): _______________________________________________________________________________________________
☐ Full Kitchen ☐ Kitchenette ☐ Shower ☐ Bathtub ☐ Deck/Patio ☐ Extra Storage _____________ ☐ Private Safe
☐ Updated Flooring/Cabinets ☐ Cats Allowed ☐ Dogs Allowed ☐ Car Allowed
Other:
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On-Site Services:
☐ Multiple Dining Rooms ☐ Fitness Room ☐ Theater ☐ Hair Salon/Barber ☐ Library ☐ Business Center ☐ Transportation
☐ Pharmacy ☐ General Store ☐ Chapel ☐ Church Service ☐ Laundry Service ☐ Housekeeping ☐ Gardening Beds ☐ Wi-Fi
☐ Cable TV ☐ Dog Walker & Charge __________________________________________________________________________
Other:
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Activities Offered:
☐ Exercise Programs ☐ Crafts ☐ Cards ☐ Gardening
Other:
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Wellness Services:
☐ 24-Hour Care Managers (bathing & dressing) ☐ Full-time Licensed Nurse ☐ Emergency Pendant
Other:
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Food Services:
Chef Experience (years) _______ Fresh Food ____% Frozen Food _____% ☐ Cultural Food Variety ☐ Positive Food Reviews
Other:
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Reviews Site: ______________________________________________________________________________________________