Program Interest Form | Rose Life Homes

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Call Us Today : (803) 844-8411

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Program Interest Form
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FAQ

Join Our Waitlist

First name

Last name

Phone

Income Source*

Monthly Income*

$

Rooming Arrangement*

Shared room

Private room

Do you have a mental health diagnosis?*

Yes

No

Do you take medication?*

Yes

No

Do you require assistance with activities of daily living? (bathing, dressing, ambulating, etc.)*

Yes

No

Notice: We do not provide medical care or assistance with activities of daily living. All residents must be functionally independent.

How soon are you looking to move?

Contact Us

Have questions?

We’d love to hear from you.

📞 Phone: (803) 844-8411

📧 Email: info@roselifehomes.com

🕒 Hours: Monday–Saturday, 8am–6pm

South Carolina Service Areas:

Midlands

Georgia Service Areas:

CSRA

© 2025 by Rose Life Homes Ltd Co.

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