Senior Decor Client Intake Form

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Senior Decor understands that there are challenges and struggles when transitioning your loved one into a new home. We are here to help! We offer personalized furniture packages for seniors moving into a senior community based on their likes, needs, and experiences. Help us get to know your family member. Please fill out this form so that we can create the perfect package for you and your family during this transitional period.

Client & Resident Information

Client First Name*

Client Last Name*

Client Phone*

Client Email*

Client Relationship to Resident:

Resident Name*

Community Name*

Type of Care*

Independent Living Assisted Living Memory Care

Room Type*

Room Square Footage*

Are you able to provide a floor plan?*

Do you have a budget in mind?*

Projected move in date?*

Resident Age*

Resident Height*

Resident Weight*

Mobility Restrictions*

Mobility Equipment*

Walker Wheelchair Cane

Incontinence Concerns?*

Other Medical Concerns*

In order to help us create a personalized package, please tell us about your loved one.

We would like to know his/her hobbies, favorite colors, previous careers, and anything else that might help us create the perfect home for him/her. Relax and let us do the work for you!

Apartment Breakdown

Living Room

Color Preferences*

Wood Colors*

Fabric Colors*

Loveseat*

Sofa*

Both Loveseat and Sofa:

Chair*

Recliner*

Recliner Style

Coffee Table*

Ottoman*

Cocktail Ottoman*

End Tables*

Lamps*

Entertainment Consoles*

Art & Accessories*

Bed Room

Bed Size*

Headboard Type*

Hybrid Mattress: Mattress that forms to your body, creating a customized sleep experience -supportive and soft. The fabric covering the mattress is breathable, which allows for a comfortable night’s sleep no matter the season. The mattress features a four-layer construction that consists of 1.3 inch quilted cover which contains green tea extract for freshness, 1 inch of super soft foam, 1 inch of super soft convoluted foam, and 8.7 inches 14/13 gauge pocket coil unit. This hybrid mattress is suitable for an adjustable base.

Mattress Firmness: Mattress Firmness is rated 1 (super soft) - 10 (hard)*

Dresser*

Night Stand*

Bedroom Desk*

Chair in Bedroom*

Type of Chair in Bedroom*

Bed Linens*

Sheets*

Quilt / Bedspread / Blanket*

Comforter*

Pillow Inserts*

Lamps*

Bathroom

Master Bathroom*

Guest Bathroom*

Kitchen

Package Options*

Noteworthy

We do not hang TVs
We do not provide or hang drapery
We do not provide electronics
Toasters, coffee makers, TV, etc.
If we do the install, we can hang personal art as long as it is in the apartment on the day of install. Nothing heavy. No heavy art or mirrors.

How did you hear about us?*

NEED HELP FAST?TALK TO A CONSULTANT NOW

OPTION A

Call or Text Us Now

404-482-1505

OPTION B

Request a Call Back