Evangelical Homes of Michigan

Evangelical Homes of Michigan - United Church of Christ

Contact Us

To receive information about Evangelical Homes of Michigan please fill out the form below. We will send you a brochure about our organization and the services we offer.

First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Area Code and Phone Number *	-
E-Mail Address *

For whom are you seeking information for:
	Yourself
	Spouse
	Parent
	Friend
	Other

What type of care are you seeking:
	Long Term Care (Nursing Home)
	Assisted Living
	Independent Living
	HUD Housing
	Dementia
	Sub Acute Care
Age of person seeking information for:
	<50 years old
	51-60 years old
	61-70 years old
	71-80 years old
	81-90 years old
	91+ years old

Please include any comments, remarks or questions:

* Denotes a required field