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Whiteside County Long Term Care/ Congregate Care Survey
This survey is for any congregate, residential care facility in Whiteside County. Please Complete a separate survey for each facility within Whiteside County
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* Indicates required question
Email
*
Your email
Facility Name
*
Your answer
Facility Type
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Number of Beds
*
Your answer
Current Number of Residents/ Clients
*
Estimate for number of clients is acceptable
Your answer
Number of Staff
*
Your answer
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