Admission Forms
We make serving our residents and families a top priority at Azura Assisted Living and Memory Care and ensuring that every communication and experience is EXCEPTIONAL. Below is a listing of some of the initial paperwork needing to be completed prior to admission.
Please feel free to call 800-842-9872 or email admissions@azuraliving.com with any questions or for more information about our care and services.
Confidential Application For Residency
Azura’s Confidential Residency Agreement helps our Admissions Team understand the financial picture of each resident, while helping us to better understand who may support the potential resident’s care and financial needs.
This document can be filled out by the resident or anyone assisting them. *Proof of financial information can be emailed to admissions@azuraliving.com with the subject line of the resident’s name.
Authorization for Release of Resident Records
Each resident of Azura is extended a personalized visit to assess their social and physical care needs. This document allows us to collect healthcare information regarding these needs and their medications directly from the person’s physician.
Please note this document must be filled out by the resident, unless an activated Healthcare Power of Attorney or court-appointed Guardian is in place, then that representative would sign.
Resident Quality of Life Profile
At Azura we look to understand the likes and dislikes of each resident and use this information to build a personalized plan of care and engagements for the resident. This tool helps us learn the MOSAIC of a person’s life story and build a MOSAIC that supports them to live the highest Quality of Life possible.
Azura’s MOSAIC Quality of Life Profile may be completed by the resident or anyone assisting them.
Podiatry Form
At Azura, we offer podiatry services through Preferred Podiatry Group for your loved one. Please fill out this form to enroll in podiatry services.
Azura’s Podiatry Form may be completed by the resident or anyone assisting them.
Psychiatry Services Consent Form
At Azura, we offer psychiatry services through Independent Psychiatric Consultants for your loved one. Please fill out this form to enroll in psychiatry services.
Azura’s Psychiatry Form may be completed by the resident or anyone assisting them.
Wait List Form
At Azura, we offer a wait list form to ensure your loved one is placed at the home of your desire. Please fill out the form to be put on the wait list.
Azura’s Wait List Form may be completed by the resident or anyone assisting them.
ACH Form FOR DEPOSIT ONLY
At Azura, we offer options to auto pay your rent. Please fill out the form to set up auto pay.
Azura’s Wait List Form may be completed by the resident or anyone assisting them.
Bluestone Form
Bluestone Physician Services offered for Oconomowoc, Oak Creek, Kenosha, Oshkosh, Brookfield.
Bluestone Form to be filled out if seeking physician services from Bluestone.
Early Memory Loss Class Enrollment Form
Click ‘apply now’ to access enrollment forms for the Early Memory Loss Class
Oak Medical Form
Oak Medical services offered for Beloit, Clinton, Monroe, Stoughton, Sheboygan, Manitowoc and Fox Point.
Cedar Medical Form (EAU CLAIRE ONLY)
Oak Leaf Services are offered for Azura of Eau Claire ONLY.
