We would love to hear from you!

If you would like an admission application for Sugar Hill, click here.

For directions, click here.

If you have any questions or comments or would like to contact us directly, please call the Director of Marketing at (413) 842-3161 or fill out our online inquiry form.

Online Application:

(*Required fields)

 

*This application is for...

Myself   A Loved One

If for a loved one please state relation:

 

*First Name                   *Last Name

Address

City                               State    ZIP


*Phone:                          *Email:

 

Marital Status

Married   Divorced   Single   Widowed

 

Are you looking for short or long-term care?

Permanent Stay   Respite Stay  Respite Stay

 

Have you had a 3-day hospital stay in the last 30 days?

Yes   No

 

Which unit are you interested in?

Traditional   Memory Impaired

 

What is the anticipated move-in date?

 

Insurance info (check all that apply):

Medicare

Medicaid

Long-Term Care Insurance

Other... (Please specify)

 

 

Net Worth:

 

Income information

Type:                             Amount:

 

How did you hear about us?

 

Additional Comments:

 

 

.©2005 Merrimack Health Group