1224 13th Street NW
Cedar Rapids, IA 52405
Phone (319) 365-9171
Fax (319) 363-5312
Contact Us

Please answer and submit the following form if you would like to receive our Meth-Wick Get Acquainted Packet. This packet of information will provide an overview of life at Meth-Wick, including styles of living, choice of building residences and resident activities. We look forward to hearing from you!

Name

Email Address

May we contact you?

Yes No

Address

City

State

ZIP

On who’s behalf are you inquiring?            

 Myself
Friend
Relative        

Which style of living are you/your friend/relative interested in? Select one.
Independent Living
Independence Plus (for independent seniors who prefer assistance with some daily tasks)
Assisted Living
Nursing Care or Dementia Care
Not Sure
This form and its html form processor supplied by www.tectite.com.