Senior Life Solutions Form

Fill out our form below for more information about Senior Life Solutions. Call 319-293-8740 or email seniorlifesolutions@vbch.org if you have any questions.

Have you lost interest in activities you previously enjoyed?
Yes
No
Have you recently lost a loved one?
Yes
No
Have you experienced feelings of sadness or grief lasting longer that two weeks?
Yes
No
Have you experienced a loss of energy or feeling tired all the time?
Yes
No
Do you have a chronic health condition?
Yes
No
Have you had a recent health diagnosis?
Yes
No
Have you experienced changes is appetite? (eating too much or too little)
Yes
No
Have you experienced a change in sleeping patterns? (sleeping too much or too little)
Yes
No
Have you had trouble concentrating or thinking clearly?
Yes
No
Do you feel hopeless, like you've lost control of your life?
Yes
No
Do you feel isolated or lonely?
Yes
No
Are you the primary caregiver for a friend or loved one?
Yes
No

Have you answered 'Yes' to any of these questions? If so, Senior Life Solutions may be a great fit for your needs. Please include your contact information below, and a member of our team will reach out.

First Name
Last Name

Phone
Email Address

To report a Compliance or Privacy concern or incident, please contact compliance@vbch.org.
You can also contact our Compliance Officer; Lynn Kracht at 319-293-8716 or Lynn.Kracht@vbch.org.

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If you speak another language, assistance services, free of charge, are available to you. Call 1-319-293-3171

Senior Life Solutions Form

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