Elderlink, Inc., Nursing Home Information & Referral, Santa Monica, CA
Licensed by California Department of Public Health
Certified by Department of Social Services
24 Hour Helpline
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All Facilities are Screened and Evaluated by ELDERLINK.
Call for a free personalized list of referrals based on individual needs
or complete the form below

Referral Request Form

Please fill out this form to the best of your ability. Required Items are shown in Red.
After this form is received by ELDERLINK a Care Counselor will assess the information you have provided and based on that evaluation create a list of appropriate facilities that will meet the individual's needs. Please provide as much information as possible, if we have further questions we will contact you.

Your privacy is important to us.  Any information you provide will be held in strictest confidence. We WILL NOT use any information on this form except as required to respond to your request.

Please click here to review the ELDERLINK Terms of Use & Disclaimer

Your Contact Information

Senior's Information

Home With Relatives Facility
  • Heart disease
  • Alzheimer’s Disease
  • Stroke
  • Parkinson’s Disease
  • Emphysema
  • Mental Illness
  • Dementia
  • Diabetic
  • TIA’s
  • Depression
  • Healthy
  • Multiple Sclerosis
  • Congestive Heart Disease
  • Macular Degeneration
  • Short Term Memory Loss

  • Bathing
  • Walking
  • Dressing
  • Injections
  • Medications
  • Catheter
  • Incontinence
  • Colostomy
  • Toileting
  • Feeding
  • None
  • Self Sufficient
  • Self Sufficient
  • Oxygen
  • Forgetful
  • Wanderer
  • Confused
  • Tube Feeding
  • Cane
  • IV
  • Walker
  • Aphasia
  • Wheelchair
  • Smoker
  • Electric cart
  • Pets
  • Bedridden
  • Blind
  • Partially Sighted
  • Deaf
  • Hard of Hearing

Additional Information



Other?

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