Admission Agreement Form
Welcome to Alondra Guest Home's digital intake process. This secure form allows you to complete your admission agreement online at your own pace.
Secure & HIPAA Compliant
Your information is encrypted and protected in compliance with HIPAA regulations. We take your privacy and security seriously.
Complete on Your Mobile Device
Scan this QR code with your phone's camera to complete this form on your mobile device. Perfect for filling out the form together with family members or while on the go.
Before You Begin
Please have the following information ready:
- Resident's personal information (name, birthdate)
- Responsible person's contact information
- Preferred move-in date
- Room preference and payment details
This form typically takes 15-20 minutes to complete. Your progress is saved automatically.
Resident Information
Resident Information
We'll work with you to accommodate this date when possible
Need assistance? Call us at (562) 863-7630 or email [email protected]. We're happy to help you complete this form over the phone.
Need Help?
Our staff is available to assist you with the intake process.