Bridges to Mobility: A Service to Promote Mobility

Assessment

This questionnaire will assist Bridges to Mobility, Inc.® in making
an assessment that fits your individual needs, specific resources
can then be identified. This form can be printed and faxed to
(503) 557-1790, or simply press the send button at the bottom of the form on your computer screen.

Please take a moment to tell Bridges to Mobility, Inc ® how we might be able to assist you:

Sturdy Hand Rails/Grab Bars	Modular Access Ramps

Home Remodeling:: Bathroom Kitchen Closets, Doorways

Additional Information:

Refinancing your current home Selling your home

Finding a Real estate agent who focuses Buying a new home
on homes for mobility

Referral service for assisted living and retirement centers

To finalize your request, please complete the following.

Name

Address

City State

Zip Code Phone

E-mail

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