{"id":5530,"date":"2022-08-10T14:52:12","date_gmt":"2022-08-10T19:52:12","guid":{"rendered":"https:\/\/www.bentonhouse.com\/?page_id=5530"},"modified":"2024-08-20T07:43:16","modified_gmt":"2024-08-20T12:43:16","slug":"caregiver-review","status":"publish","type":"page","link":"https:\/\/www.bentonhouse.com\/caregiver-review\/","title":{"rendered":"Caregiver Review"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; disabled_on=&#8221;off|off|off&#8221; module_id=&#8221;interior-slider&#8221; _builder_version=&#8221;3.22&#8243;][et_pb_fullwidth_slider use_bg_overlay=&#8221;off&#8221; use_text_overlay=&#8221;off&#8221; module_class=&#8221; et_pb_row_fullwidth&#8221; _builder_version=&#8221;4.9.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; vertical_offset_tablet=&#8221;0&#8243; horizontal_offset_tablet=&#8221;0&#8243; width_tablet=&#8221;80px&#8221; width_phone=&#8221;50px&#8221; 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text_line_height=&#8221;1.6em&#8221; header_text_align=&#8221;center&#8221; text_orientation=&#8221;center&#8221;]<\/p>\n<p>At Benton House, we are proud of the thousands of seniors we serve in our communities. But we are equally proud of the tens of thousands of families we&#8217;ve helped find solutions in their homes.<\/p>\n<p>[\/et_pb_text][et_pb_code disabled_on=&#8221;off|off|off&#8221; admin_label=&#8221;Divider&#8221; _builder_version=&#8221;4.3.2&#8243; vertical_offset_tablet=&#8221;0&#8243; horizontal_offset_tablet=&#8221;0&#8243; text_orientation=&#8221;center&#8221; z_index_tablet=&#8221;0&#8243;][et_pb_section global_module=\"2281\"][\/et_pb_section][\/et_pb_code][et_pb_code module_id=&#8221;careview-sec2-code1&#8243; _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221;]<script type=\"text\/javascript\">var 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/wp-json\/wp\/v2\/pages\/5530\/#gf_10' data-formid='10' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_1\" ><h3>Complete the info below to receive your complimentary copy of our Confident Caregiver Workbook.<\/h3><\/div><fieldset id=\"field_10_2\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_10_2'>\n                            \n                            <span id='input_10_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_10_2_3' value='' tabindex='50'  aria-required='true'     \/>\n                                                    <label for='input_10_2_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><div id=\"field_10_3\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_3\" ><label class='gfield_label gform-field-label' for='input_10_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_10_3' type='tel' value='' class='large' tabindex='54'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_4\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_4\" ><label class='gfield_label gform-field-label' for='input_10_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_10_4' type='email' value='' class='large' tabindex='55'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_5\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\" ><label class='gfield_label gform-field-label' for='input_10_5'>Senior in Need<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_10_5' class='large gfield_select' tabindex='56'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select an option...<\/option><option value='Self' >Self<\/option><option value='Parent' >Parent<\/option><option value='Other Family' >Other Family<\/option><option value='Friend' >Friend<\/option><\/select><\/div><\/div><div id=\"field_10_6\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_6\" ><label class='gfield_label gform-field-label' for='input_10_6'>I prefer to receive my information by<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_10_6' class='large gfield_select' tabindex='57'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select an option...<\/option><option value='Text' >Text<\/option><option value='Email' >Email<\/option><option value='Mail' >Mail<\/option><\/select><\/div><\/div><fieldset id=\"field_10_16\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_16\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_16' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_16_1_container' >\n                                        <input type='text' name='input_16.1' id='input_10_16_1' value='' tabindex='58'   aria-required='true'    \/>\n                                        <label for='input_10_16_1' id='input_10_16_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_16_3_container' >\n                                    <input type='text' name='input_16.3' id='input_10_16_3' value='' tabindex='59'   aria-required='true'    \/>\n                                    <label for='input_10_16_3' id='input_10_16_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_16_4_container' >\n                                        <input type='text' name='input_16.4' id='input_10_16_4' value='' tabindex='61'     aria-required='true'    \/>\n                                        <label for='input_10_16_4' id='input_10_16_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_16_5_container' >\n                                    <input type='text' name='input_16.5' id='input_10_16_5' value='' tabindex='62'   aria-required='true'    \/>\n                                    <label for='input_10_16_5' id='input_10_16_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_16.6' id='input_10_16_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_19\" class=\"gfield gfield--type-select gfield--width-full community_select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_19\" ><label class='gfield_label gform-field-label' for='input_10_19'>Select Community of interest<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_10_19' class='large gfield_select' tabindex='63'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='state Florida' >Florida<\/option><option value='Benton House of Clermont' >Benton House of Clermont<\/option><option value='state Georgia' >Georgia<\/option><option value='Benton House of Covington' >Benton House of Covington<\/option><option value='Benton House of Decatur' >Benton House of Decatur<\/option><option value='Benton House of Douglasville' >Benton House of Douglasville<\/option><option value='Benton House of Grayson' >Benton House of Grayson<\/option><option value='Benton House of Newnan' >Benton House of Newnan<\/option><option value='Benton Village of Stockbridge' >Benton Village of Stockbridge<\/option><option value='Benton House of Sugar Hill' >Benton House of Sugar Hill<\/option><option value='Benton House of Woodstock' >Benton House of Woodstock<\/option><option value='state Kansas' >Kansas<\/option><option value='Benton House of Lenexa' >Benton House of Lenexa<\/option><option value='Benton House of Olathe' >Benton House of Olathe<\/option><option value='state Missouri' >Missouri<\/option><option value='Benton House of Blue Springs' >Benton House of Blue Springs<\/option><option value='Benton House of Raymore' >Benton House of Raymore<\/option><option value='Benton House of Staley Hills' >Benton House of Staley Hills<\/option><option value='Benton House of Tiffany Springs' >Benton House of Tiffany Springs<\/option><option value='state South Carolina' >South Carolina<\/option><option value='The Garden House of Anderson' >The Garden House of Anderson<\/option><\/select><\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_8\" ><h3>Step One: Identify Risks. Step Two: Get Solutions.<\/h3>\n<p>Our offer to assist extends beyond a complimentary workbook. Also access our team of dedicated caregiving experts to help you complete it.<\/p>\n<p>In as little as 30 minutes you can complete the workbook with one of our staff. We\u2019ll then review your information and provide you a full set of recommendations and support tools for you to use at home.<\/p>\n<p>This service is complimentary for EVERY family, not just those considering a move to Benton House. So wherever you are in your caregiving journey, please let us help.<\/p>\n<\/div><div id=\"field_10_9\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_9\" ><label class='gfield_label gform-field-label' for='input_10_9'>Please select one:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_10_9' class='large gfield_select' tabindex='64'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Phone Visit' >Phone Visit<\/option><option value='Virtual Visit' >Virtual Visit<\/option><option value='Community Visit' >Community Visit<\/option><option value='Home Visit' >Home Visit<\/option><option value='Workbook Only' >Workbook Only<\/option><\/select><\/div><\/div><fieldset id=\"field_10_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half challenges_checkboxes field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What Challenge do you face?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_10_10'><div class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Medications'  id='choice_10_10_1' tabindex='65'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Medications<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Nutrition\/Fitness'  id='choice_10_10_2' tabindex='66'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>Nutrition\/Fitness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Home Safety'  id='choice_10_10_3' tabindex='67'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>Home Safety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Social Isolation'  id='choice_10_10_4' tabindex='68'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_4' id='label_10_10_4' class='gform-field-label gform-field-label--type-inline'>Social Isolation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Planning'  id='choice_10_10_5' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_5' id='label_10_10_5' class='gform-field-label gform-field-label--type-inline'>Planning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Bonus Material: Senior Fraud and Abuse'  id='choice_10_10_6' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_6' id='label_10_10_6' class='gform-field-label gform-field-label--type-inline'>Bonus Material: Senior Fraud and Abuse<\/label>\n\t\t\t\t\t\t\t<\/div><button type=\"button\" id=\"button_10_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/fieldset><fieldset id=\"field_10_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_15\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Need a Backup Plan for Home? 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button_alignment=&#8221;center&#8221; button_alignment_tablet=&#8221;&#8221; button_alignment_phone=&#8221;&#8221; button_alignment_last_edited=&#8221;on|desktop&#8221; disabled_on=&#8221;off|off|off&#8221; admin_label=&#8221;Button &#8211; Apply Now&#8221; _builder_version=&#8221;4.9.4&#8243; custom_button=&#8221;on&#8221; button_text_size=&#8221;24&#8243; button_text_color=&#8221;#ffffff&#8221; button_bg_color=&#8221;#c0b45f&#8221; button_border_width=&#8221;0&#8243; background_layout=&#8221;dark&#8221; custom_margin=&#8221;10px||||false|false&#8221; locked=&#8221;off&#8221; button_text_size__hover_enabled=&#8221;off&#8221; button_one_text_size__hover_enabled=&#8221;off&#8221; button_two_text_size__hover_enabled=&#8221;off&#8221; button_text_color__hover_enabled=&#8221;off&#8221; button_one_text_color__hover_enabled=&#8221;off&#8221; button_two_text_color__hover_enabled=&#8221;off&#8221; button_border_width__hover_enabled=&#8221;off&#8221; button_one_border_width__hover_enabled=&#8221;off&#8221; button_two_border_width__hover_enabled=&#8221;off&#8221; button_border_color__hover_enabled=&#8221;off&#8221; button_one_border_color__hover_enabled=&#8221;off&#8221; button_two_border_color__hover_enabled=&#8221;off&#8221; button_border_radius__hover_enabled=&#8221;off&#8221; button_one_border_radius__hover_enabled=&#8221;off&#8221; button_two_border_radius__hover_enabled=&#8221;off&#8221; button_letter_spacing__hover_enabled=&#8221;off&#8221; button_one_letter_spacing__hover_enabled=&#8221;off&#8221; button_two_letter_spacing__hover_enabled=&#8221;off&#8221; button_bg_color__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221;][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>At Benton House, we are proud of the thousands of seniors we serve in our communities. But we are equally proud of the tens of thousands of families we&#8217;ve helped find solutions in their homes.<div class=\"et_pb_section et_pb_section_1 et_section_regular\" >\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_row et_pb_row_0\">\n\t\t\t\t<div class=\"et_pb_column et_pb_column_4_4 et_pb_column_0  et_pb_css_mix_blend_mode_passthrough et-last-child\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module et_pb_code et_pb_code_0  et_pb_text_align_center\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_code_inner\"><div class=\"svg_divider\"><img decoding=\"async\" src=\"\/wp-content\/themes\/Divi-Child\/images\/divider.svg\" alt=\"Divider\" \/><\/div><\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/wp-json\/wp\/v2\/pages\/5530\/#gf_10' data-formid='10' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_1\" ><h3>Complete the info below to receive your complimentary copy of our Confident Caregiver Workbook.<\/h3><\/div><fieldset id=\"field_10_2\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name no_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_10_2'>\n                            \n                            <span id='input_10_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_10_2_3' value='' tabindex='50'  aria-required='true'     \/>\n                                                    <label for='input_10_2_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            \n                            \n                        <\/div><\/fieldset><div id=\"field_10_3\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_3\" ><label class='gfield_label gform-field-label' for='input_10_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_10_3' type='tel' value='' class='large' tabindex='54'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_4\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_4\" ><label class='gfield_label gform-field-label' for='input_10_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_10_4' type='email' value='' class='large' tabindex='55'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_5\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\" ><label class='gfield_label gform-field-label' for='input_10_5'>Senior in Need<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_10_5' class='large gfield_select' tabindex='56'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select an option...<\/option><option value='Self' >Self<\/option><option value='Parent' >Parent<\/option><option value='Other Family' >Other Family<\/option><option value='Friend' >Friend<\/option><\/select><\/div><\/div><div id=\"field_10_6\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_6\" ><label class='gfield_label gform-field-label' for='input_10_6'>I prefer to receive my information by<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_10_6' class='large gfield_select' tabindex='57'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select an option...<\/option><option value='Text' >Text<\/option><option value='Email' >Email<\/option><option value='Mail' >Mail<\/option><\/select><\/div><\/div><fieldset id=\"field_10_16\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_16\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_16' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_16_1_container' >\n                                        <input type='text' name='input_16.1' id='input_10_16_1' value='' tabindex='58'   aria-required='true'    \/>\n                                        <label for='input_10_16_1' id='input_10_16_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_16_3_container' >\n                                    <input type='text' name='input_16.3' id='input_10_16_3' value='' tabindex='59'   aria-required='true'    \/>\n                                    <label for='input_10_16_3' id='input_10_16_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_16_4_container' >\n                                        <input type='text' name='input_16.4' id='input_10_16_4' value='' tabindex='61'     aria-required='true'    \/>\n                                        <label for='input_10_16_4' id='input_10_16_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_16_5_container' >\n                                    <input type='text' name='input_16.5' id='input_10_16_5' value='' tabindex='62'   aria-required='true'    \/>\n                                    <label for='input_10_16_5' id='input_10_16_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_16.6' id='input_10_16_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_19\" class=\"gfield gfield--type-select gfield--width-full community_select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_19\" ><label class='gfield_label gform-field-label' for='input_10_19'>Select Community of interest<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_10_19' class='large gfield_select' tabindex='63'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='state Florida' >Florida<\/option><option value='Benton House of Clermont' >Benton House of Clermont<\/option><option value='state Georgia' >Georgia<\/option><option value='Benton House of Covington' >Benton House of Covington<\/option><option value='Benton House of Decatur' >Benton House of Decatur<\/option><option value='Benton House of Douglasville' >Benton House of Douglasville<\/option><option value='Benton House of Grayson' >Benton House of Grayson<\/option><option value='Benton House of Newnan' >Benton House of Newnan<\/option><option value='Benton Village of Stockbridge' >Benton Village of Stockbridge<\/option><option value='Benton House of Sugar Hill' >Benton House of Sugar Hill<\/option><option value='Benton House of Woodstock' >Benton House of Woodstock<\/option><option value='state Kansas' >Kansas<\/option><option value='Benton House of Lenexa' >Benton House of Lenexa<\/option><option value='Benton House of Olathe' >Benton House of Olathe<\/option><option value='state Missouri' >Missouri<\/option><option value='Benton House of Blue Springs' >Benton House of Blue Springs<\/option><option value='Benton House of Raymore' >Benton House of Raymore<\/option><option value='Benton House of Staley Hills' >Benton House of Staley Hills<\/option><option value='Benton House of Tiffany Springs' >Benton House of Tiffany Springs<\/option><option value='state South Carolina' >South Carolina<\/option><option value='The Garden House of Anderson' >The Garden House of Anderson<\/option><\/select><\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_8\" ><h3>Step One: Identify Risks. Step Two: Get Solutions.<\/h3>\n<p>Our offer to assist extends beyond a complimentary workbook. Also access our team of dedicated caregiving experts to help you complete it.<\/p>\n<p>In as little as 30 minutes you can complete the workbook with one of our staff. We\u2019ll then review your information and provide you a full set of recommendations and support tools for you to use at home.<\/p>\n<p>This service is complimentary for EVERY family, not just those considering a move to Benton House. So wherever you are in your caregiving journey, please let us help.<\/p>\n<\/div><div id=\"field_10_9\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_9\" ><label class='gfield_label gform-field-label' for='input_10_9'>Please select one:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_10_9' class='large gfield_select' tabindex='64'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Phone Visit' >Phone Visit<\/option><option value='Virtual Visit' >Virtual Visit<\/option><option value='Community Visit' >Community Visit<\/option><option value='Home Visit' >Home Visit<\/option><option value='Workbook Only' >Workbook Only<\/option><\/select><\/div><\/div><fieldset id=\"field_10_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half challenges_checkboxes field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What Challenge do you face?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_10_10'><div class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Medications'  id='choice_10_10_1' tabindex='65'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Medications<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Nutrition\/Fitness'  id='choice_10_10_2' tabindex='66'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>Nutrition\/Fitness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Home Safety'  id='choice_10_10_3' tabindex='67'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>Home Safety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Social Isolation'  id='choice_10_10_4' tabindex='68'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_4' id='label_10_10_4' class='gform-field-label gform-field-label--type-inline'>Social Isolation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Planning'  id='choice_10_10_5' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_5' id='label_10_10_5' class='gform-field-label gform-field-label--type-inline'>Planning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Bonus Material: Senior Fraud and Abuse'  id='choice_10_10_6' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_6' id='label_10_10_6' class='gform-field-label gform-field-label--type-inline'>Bonus Material: Senior Fraud and Abuse<\/label>\n\t\t\t\t\t\t\t<\/div><button type=\"button\" id=\"button_10_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/fieldset><fieldset id=\"field_10_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_15\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Need a Backup Plan for Home? 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