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Resident Questionnaire & Waitlist

Thank you for considering HD Living Solutions. This questionnaire helps us understand if our independent shared living environment is the right fit for you or your loved one. Please answer honestly so we can ensure the best support and community experience.

About the Prospective Resident

Living Situation & Timing

Current Living Situation
Living alone
Living with family
Assisted living / facility
Hospital / rehab
Other - please specify
When are you hoping to move?

We respect your privacy and only use this information to contact you about housing options.

Resident Questionnaire & Waitlist

This questionnaire helps us understand your unique transition goals and care requirements. Completing this form ensures we have the information needed to contact you about housing options and add you to our waitlist.

1. About the Prospective Resident

We respect your privacy and only use this information to contact you about housing options.

Lifestyle & Preferences

Lifestyle & Preferences

Section 1: Living Situation & Timing

Please tell us about your current home and when you are considering a move.

Current living situation
Living alone
Living with spouse/partner
Living with family
Assisted living
Other
Move timeline
Immediately
Within 3 months
3 to 6 months
6 months to a year
Just researching

Section 2: Social & Home Preferences

Help us understand what environment makes you feel most comfortable.

Room sharing preference
Private room
Shared room
No preference
Environment noise and activity levels
Quiet and peaceful
Moderate activity
Lively and social
Daytime interests

Select all activities that interest you.

Functional Assessment & Health Needs

To better understand your daily living requirements and support aids, please complete the functional assessment overview below.

Section 1: Daily Independence

Bathing and dressing
Yes
With some help
No
Managing medications
Yes
With some help
No
Preparing simple meals
Yes
With some help
No
Basic house chores
Yes
With some help
No

We respect your privacy and only use this information to contact you about housing options.

Decision & Contact

Who is filling this out?
Myself
Family member
Friend
Case manager / social worker
Best time to reach you
Preferred contact method

Consent & Waitlist

We respect your privacy and only use this information to contact you about housing options.

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