Grand Traverse Pavilions

Interest Survey

The Cottages – Interest Survey / Questionnaire

Thank you for your interest in The Cottages. For more information, please fill out this questionnaire and click the “Send” button below to send it to Grand Traverse Pavilions.

Would you strongly consider residency in The Cottage Apartments for yourself, spouse, or other family member?

YES

Number of individuals to reside in apartment:

ONE

TWO

Apartment preference (please check)

	Studio
	1-bedroom
	2-bedroom
	Handicap Accessible

What would be your anticipated move-in date?
What is your approximate price range?	$ per month

What optional services would be most important to you? (please check all that apply)

Transportation	Shopping/Errand Service	Medication Management
Expanded Housekeeping	Room Service (meal delivery)	Therapy Services
Pharmacy Service	Personal Care Assistance	Home Health Care

Are you interested in receiving additional information on The Cottage Apartments?

	YES	(if yes, please complete section below)
	NO

NAME:
ADDRESS:
TELEPHONE (H):
TELEPHONE (W):
EMAIL ADDRESS:

Do you have a friend or relative who you would like to receive information?

NAME:
ADDRESS:
TELEPHONE (H):
TELEPHONE (W):
EMAIL ADDRESS :