Phone number (mandatory)

Cell phone number (mandatory)

City (mandatory)

Home State (mandatory)

E-mail (mandatory)

1.- What is the city or state of your preference
to hire the service in Mexico?

2.- What is your minimum monthly budget in USD
for the payment of the services you require? (mandatory)

3.- Service that requires:
Assisted livingMemory CareNursery 24/7Medical Tourism

4.- Your family member or person in need of assistance has some memory problem:
Alz heimerDementiaParkinsonAny other medication or special care

5.- Your room should be:
IndividualShareSuite

6.- The level of assistance of the person or family member considers it:
BasicIntermediateHigh

7.- How long do you need the service?
1 MonthMínimum stayPermanent 24/7

8.- On what date could you visit the house of your interest to schedule an appointment?

9.- What would be the house of your interest?

I haven´t decided yet

Subject

Additional Comments or observations: