Contact – unwindingessenceilh

Contact Us

470-236-3273

info@unwindingessenceilh.com

United States

Learn more about our independent shared living homes and the application process.

Please complete this brief pre-screening questionnaire to help us better understand your needs before we contact you.

Name

Phone Number

Date of birth

Current Address

Where were you referred from?

Do you have a steady source of income?

What is your main source of income?

What is your estimated monthly income?

Do you receive Food Stamps/ EBT (SNAP benefits)

Do you have a working phone we can use to contact you?

Are you able to live independently without daily assistance?

Do you currently receive help with daily activities ( cleaning, cooking, hygiene, etc)?

Are you currently taking any prescribed medication?

Do you have any difficulty accessing your medications (cost, transportation, insurance, etc)?

What type of room are you looking for?

When do you need housing?

Have you even been evicted from a previous residence?

Have you ever been convicted of a felony?

Are you a registered sex offender?

Are you willing to follow house rules (no drugs, no unapproved guests, quiet hours, cleanliness etc)?

Do you smoke?

Do you have any pets?

Why are you seeking housing at this time?

Is there anything else you’d like us to know?

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