Intake form

Help us serve you better

Name *

Email address *

Preferred move-in date

Type of residence desired

Length of stay

Number of bedrooms needed

Preferred location

Current living situation

Please select at least one option.

Living alone

With family

With friends

In assisted living

Interests and hobbies

Additional comments or questions

Which service or services are you interested in?

Please select at least one option.

Flexible shared housing

Community engagement

Simple membership model

Additional questions or comments

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Starr Haven Living LLC