CALL US: (800) 842-9872

Admission Forms

We make serving our residents and families a top priority at Azura Assisted Living and Memory Care and ensuring that every communication and experience is EXCEPTIONAL. Below is a listing of some of the initial paperwork needing to be completed prior to admission.

Please feel free to call 800-842-9872 or email with any questions or for more information about our care and services.

Confidential Application For Residency

Azura’s Confidential Residency Agreement helps our Admissions Team understand the financial picture of each resident, while helping us to better understand who may support the potential resident’s care and financial needs.

This document can be filled out by the resident or anyone assisting them. *Proof of financial information can be emailed to with the subject line of the resident’s name.

Authorization for Release of Resident Records

Each resident of Azura is extended a personalized visit to assess their social and physical care needs.  This document allows us to collect healthcare information regarding these needs and their medications directly from the person’s physician. 

Please note this document must be filled out by the resident, unless an activated Healthcare Power of Attorney or court-appointed Guardian is in place, then that representative would sign.

Resident Quality of Life Profile

At Azura we look to understand the likes and dislikes of each resident and use this information to build a personalized plan of care and engagements for the resident.  This tool helps us learn the MOSAIC of a person’s life story and build a MOSAIC that supports them to live the highest Quality of Life possible.

Azura’s MOSAIC Quality of Life Profile may be completed by the resident or anyone assisting them.

Early Memory Loss Class Enrollment Form

Click ‘apply now’ to access enrollment forms for the Early Memory Loss Class.

Psychiatry Services Consent Form

At Azura, we offer psychiatry services through Independent Psychiatric Consultants for your loved one.  Please fill out this form to enroll in psychiatry services. 

Azura’s Psychiatry Form may be completed by the resident or anyone assisting them.

Wait List Form

At Azura, we offer a wait list form to ensure your loved one is placed at the home of your desire.   Please fill out the form to be put on the wait list. 

Azura’s Wait List Form may be completed by the resident or anyone assisting them.


At Azura, we offer options to auto pay your rent.   Please fill out the form to set up auto pay. 

Azura’s Wait List Form may be completed by the resident or anyone assisting them.

Bluestone Form

Bluestone Physician Services offered for Oconomowoc, Oak Creek, Kenosha, Oshkosh, Brookfield.

Bluestone Form to be filled out if seeking physician services from Bluestone.

Oak Medical Form

Oak Medical services offered for Beloit, Clinton, Monroe, Stoughton, Sheboygan, Manitowoc and Fox Point.


Sequoia Medical Form

Sequoia Medical is offered for Azura of Eau Claire ONLY. Click the button to apply now.


Connect with Our Care Teams

"We were so happy we found Azura for my mother. The staff were exceptional--the caregivers, the nurses, the director, even the maintenance man did everything they could to make my mother comfortable and feel welcome. We couldn't have asked for better and would highly recommend Azura for anyone looking for a caring place for their relative."
Review Posted by Kate S.