Medcenter One Living Centers

Admissions inquiry

I understand that this is only an inquiry form and does not obligate me to services of Medcenter One Living Centers, nor does it guarantee that there will be a service available for me. Should I accept a service in Medcenter One Living Centers, I will need to provide more information and a contract will be signed.

General information about the resident:
First name:
Last name:
Address:
City:
State:
ZIP:
Telephone:
E-mail:
General information about the person completing the inquiry (if different than the resident):
First name:
Last name:
Address:
City:
State:
ZIP:
Telephone:
Email:

I would like more general information about:
Medcenter One Mandan Care Center off Collins
Medcenter One Mandan Living Center
Medcenter One Marillac Manor
Medcenter One Prarieview Nursing Home
Medcenter One St. Vincent's Care Center

I would like more information about:
Admissions/Eligibility
Scheduling an onsite visit at -------------------------- Mandan Care Center off Collins Mandan Living Center Marillac Manor Prairieview Nursing Home St. Vincent's
Rate information
Payment options


Additional questions/comments:

• Please enter the letters you see above in the box below.
(case sensitive)
• If you are having trouble viewing the letters, please call 701.323.1999 to
  make your request by phone.