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585-392-7171

Reservation Form


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We look forward to helping you in every step of the discovery process.

Simply fill out the form below to get started.

CLICK HERE TO FILL OUT APPLICATION
Reservation FormComplete it Here

Hilton East Reservation Form (Printable Version)

Hilton East Assisted Living Logo with Tree
Hilton East Assisted Living Community has been locally owned and operated for over 40 years, allowing us to adjust to changing needs for our residents.

Let us Help you Find the Perfect Solution!

Contact Us to Learn More!

CONTACT US

Hilton East Assisted Living Community
231 East Avenue
Hilton, NY 14468
P: 585-392-7171
E: info@hiltoneast.com

OUR MISSION

To provide quality personalized care in an environment that fosters caring independence.
Hilton East logo
  • Home
  • About Us
  • Life at Hilton East
  • Rooms & Rates
  • FAQ’s
  • Events
  • Tour Hilton East
  • Reservation Checklist
  • Reservation Form
  • Employment
  • Volunteering
  • Contact

CONTACT US

Hilton East Assisted Living Community
231 East Avenue
Hilton, NY 14468
P: 585-392-7171
E: info@hiltoneast.com

Hilton East logo

To provide quality personalized care in an environment that fosters caring independence.

  • Home
  • About Us
  • Life at Hilton East
  • Rooms & Rates
  • FAQ’s
  • Events
  • Tour Hilton East
  • Reservation Checklist
  • Reservation Form
  • Employment
  • Volunteering
  • Contact

Terms & Conditions | Privacy Policy
Copyright 2003 - 2022 Hilton East Assisted Living Community | Web Design & Hosting: B Square Web

Terms & Conditions | Privacy Policy

Copyright 2003 - 2022 Hilton East Assisted Living Community

Web Design & Hosting:   B Square Web
Reservation Form

Please complete the entire reservation form with the most up-to-date information as possible in order to expedite the admission process. (Please note, information requested is required by New York State for admission to a state-licensed care facility)

Family Information
Health Insurance
Room Request
(call for current pricing)
Financial Information

Please provide your total annual income amount including employment plus benefits for each

List notes, taxes, loans, credit cards, and other debts including dollar amounts.

All room and board payments are now required to be made via direct deposit EFT.

 

Medical Information
Please note - Hilton East only provides the following diets: Regular, No Concentrated Sweets, No Added Salt
Mental Health Information
Medical/Physical Information
Current Provider Contact Information
Additional Contacts
Reset Signature
  • Home
  • About Us
  • Life at Hilton East
  • Rooms & Rates
  • FAQ’s
  • Events
  • Tour Hilton East
  • Reservation Checklist
  • Reservation Form
  • Employment
  • Volunteering
  • Contact