{"id":5854,"date":"2022-08-30T14:39:03","date_gmt":"2022-08-30T19:39:03","guid":{"rendered":"https:\/\/www.bentonhouse.com\/?page_id=5854"},"modified":"2024-07-16T09:56:27","modified_gmt":"2024-07-16T14:56:27","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/www.bentonhouse.com\/contact-us\/","title":{"rendered":"Contact"},"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;4.3.2&#8243;][et_pb_fullwidth_slider use_bg_overlay=&#8221;off&#8221; use_text_overlay=&#8221;off&#8221; _builder_version=&#8221;4.9.4&#8243; background_color=&#8221;rgba(255, 255, 255, 0)&#8221; 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; z_index_tablet=&#8221;0&#8243; header_text_shadow_horizontal_length_tablet=&#8221;0px&#8221; 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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; sticky_transition=&#8221;on&#8221;][\/et_pb_slide][\/et_pb_fullwidth_slider][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_class=&#8221;intro&#8221; _builder_version=&#8221;3.22&#8243; top_divider_color=&#8221;#83332f&#8221; border_width_bottom=&#8221;1px&#8221; border_color_bottom=&#8221;#efefef&#8221;][et_pb_row custom_padding_last_edited=&#8221;on|desktop&#8221; _builder_version=&#8221;4.9.4&#8243; module_alignment=&#8221;center&#8221; custom_padding=&#8221;10px||5px||false|false&#8221; custom_padding_tablet=&#8221;10px||5px||false|false&#8221; custom_padding_phone=&#8221;&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.0.47&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_code admin_label=&#8221;Background Title &#8211; Design&#8221; text_orientation=&#8221;center&#8221;]<\/p>\n<div class=\"background_title\">CONTACT<\/div>\n<p>[\/et_pb_code][et_pb_blurb title=&#8221;Contact Benton House&#8221; content_max_width=&#8221;1100px&#8221; admin_label=&#8221;Benton House Design&#8221; _builder_version=&#8221;4.9.4&#8243; header_level=&#8221;h2&#8243; text_orientation=&#8221;center&#8221;]<\/p>\n<h3>The Basis for Better Living<\/h3>\n<p>[\/et_pb_blurb][et_pb_code 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_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;770px&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221;][et_pb_text admin_label=&#8221;Intro Text&#8221; _builder_version=&#8221;4.9.4&#8243; text_font_size=&#8221;24px&#8221; text_line_height=&#8221;1.4em&#8221; header_text_align=&#8221;center&#8221; text_orientation=&#8221;center&#8221;]<\/p>\n<p>Knowing your options is one of the most important steps you can take to avoid a crisis in the future. Thank you for your interest and you now have a partner in helping you determine your best plan of care!<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; admin_label=&#8221;gravity form shortcode&#8221; _builder_version=&#8221;4.9.4&#8243;]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_10\" ><label class='gfield_label gform-field-label' for='input_11_10'>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_10' id='input_11_10' 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_11_11\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below 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aria-required='true'    \/>\n                                    <label for='input_11_12_5' id='input_11_12_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_12.6' id='input_11_12_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_11_5\" 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_11_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What are you interested in?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_5'><div class='gchoice gchoice_11_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Assisted Living'  id='choice_11_5_1' tabindex='63'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_1' id='label_11_5_1' class='gform-field-label gform-field-label--type-inline'>Assisted Living<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Memory Care'  id='choice_11_5_2' tabindex='64'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_2' id='label_11_5_2' class='gform-field-label gform-field-label--type-inline'>Memory Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Adult Day Program'  id='choice_11_5_3' tabindex='65'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_3' id='label_11_5_3' class='gform-field-label gform-field-label--type-inline'>Adult Day Program<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Home Care'  id='choice_11_5_4' tabindex='66'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_4' id='label_11_5_4' class='gform-field-label gform-field-label--type-inline'>Home Care<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_6\" class=\"gfield gfield--type-select gfield--width-full community_select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_6\" ><label class='gfield_label gform-field-label' for='input_11_6'>Select Community of interest<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_11_6' class='large gfield_select' tabindex='67'   aria-required=\"true\" 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_11_7\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_7\" ><label class='gfield_label gform-field-label' for='input_11_7'>Comments\/Questions<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_11_7' class='textarea small' tabindex='68'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_14\" 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_11_14\" ><p>Have a worry that prompted your request? Feel free to check any or all of worries below and we\u2019ll be happy to provide a tool to help. <\/p><\/div><fieldset id=\"field_11_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_11_15\" ><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 ' id='input_11_15'><div class='gchoice gchoice_11_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Medications'  id='choice_11_15_1' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_1' id='label_11_15_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_11_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Nutrition\/Fitness'  id='choice_11_15_2' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_2' id='label_11_15_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_11_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='Home Safety'  id='choice_11_15_3' tabindex='71'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_3' id='label_11_15_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_11_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='Social Isolation'  id='choice_11_15_4' tabindex='72'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_4' id='label_11_15_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_11_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Planning'  id='choice_11_15_5' tabindex='73'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_5' id='label_11_15_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_11_15_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.6' type='checkbox'  value='Senior Fraud and Abuse'  id='choice_11_15_6' tabindex='74'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_6' id='label_11_15_6' class='gform-field-label gform-field-label--type-inline'>Senior Fraud and Abuse<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_13\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_13\" ><div class='ginput_container ginput_container_text'><input name='input_13' id='input_11_13' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_11_16\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_16\" ><label class='gfield_label gform-field-label' for='input_11_16'>Phone<\/label><div class='ginput_container'><input name='input_16' id='input_11_16' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_11_16'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_11' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' value='Submit' tabindex='75' \/> <input type='hidden' name='gform_ajax' value='form_id=11&amp;title=&amp;description=&amp;tabindex=49&amp;theme=gravity-theme&amp;hash=79e8470ab3496ea86b5434671a683d07' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_11' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_11' id='gform_theme_11' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_11' id='gform_style_settings_11' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_11' value='WyJbXSIsImQzYzhlYzViMDhlMWY3YWMzYzU2NzNjNzFhNDZjMmU2Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_11' id='gform_target_page_number_11' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_11' id='gform_source_page_number_11' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <input type=\"hidden\" id=\"ct_checkjs_e744f91c29ec99f0e662c9177946c627\" name=\"ct_checkjs\" value=\"0\" \/><script >setTimeout(function(){var ct_input_name = \"ct_checkjs_e744f91c29ec99f0e662c9177946c627\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '2b7b819beee5d66a42decbe10bdef0c872f7dd311c613c55e52194498122a860');}}, 1000);<\/script><label class=\"apbct_special_field\" id=\"apbct_label_id99124\" for=\"apbct__email_id__gravity_form_99124\">99124<\/label><input\n            id=\"apbct__email_id__gravity_form_99124\"\n            class=\"apbct_special_field apbct__email_id__gravity_form\"\n            name=\"apbct__email_id__gravity_form_99124\"\n            type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n            value=\"99124\" apbct_event_id=\"99124\"\n            \/><input id=\"apbct_event_id_gravity_form_99124\"\n                class=\"apbct_special_field\" name=\"apbct_event_id\" type=\"hidden\" value=\"99124\" \/><\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_11' id='gform_ajax_frame_11' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 11, 'https:\/\/www.bentonhouse.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_11').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_11');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_11').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 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contents;}jQuery('#gform_wrapper_11').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_11').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [11]);window['gf_submitting_11'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_11').text());}else{jQuery('#gform_11').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"11\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);                if (event && event.defaultPrevented) {                return;         }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_11\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_11\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_11\" );        let postRenderFired = false;                function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            jQuery( document ).trigger( 'gform_post_render', [11, current_page] );            gform.utils.trigger( { event: 'gform\/postRender', native: false, data: { formId: 11, currentPage: current_page } } );            gform.utils.trigger( { event: 'gform\/post_render', native: false, data: { formId: 11, currentPage: current_page } } );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) 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attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;770px&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.4&#8243; _module_preset=&#8221;default&#8221;][et_pb_text admin_label=&#8221;Disclaimer&#8221; _builder_version=&#8221;4.9.4&#8243; text_font_size=&#8221;24px&#8221; header_text_align=&#8221;center&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<span style=\"font-size: 14px;\"><em>Disclaimer:<\/em><\/span><br \/>\n<span style=\"font-size: 14px;\">By providing my phone number to Benton House, I agree and acknowledge that Benton House may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to opt out by replying \u201cSTOP\u201d. For more information on how your data will be handled email info@bentonhouse.com.<\/span><\/p>\n<p><span style=\"font-size: 14px;\"><em>Privacy Policy:<\/em><\/span><br \/>\n<span style=\"font-size:14px;\">No mobile information will be shared with third parties\/affiliates for marketing\/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.<\/span>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Basis for Better Living <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>Knowing your options is one of the most important steps you can take to avoid a crisis in the future. Thank you for your interest and you now have a partner in helping you determine your best plan of care!\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_11' style='display:none'><div id='gf_11' 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_11' id='gform_11'  action='\/wp-json\/wp\/v2\/pages\/5854\/#gf_11' data-formid='11' 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_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_11_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_1\" ><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 has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_1'>\n                            \n                            <span id='input_11_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_11_1_3' value='' tabindex='50'  aria-required='true'     \/>\n                                                    <label for='input_11_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_11_1_6' value='' tabindex='52'  aria-required='true'     \/>\n                                                    <label for='input_11_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_3\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_3\" ><label class='gfield_label gform-field-label' for='input_11_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_11_3' type='tel' value='' class='large' tabindex='54'  aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_11_3\"  \/><\/div><div class='gfield_description' id='gfield_description_11_3'>SMS Approved<\/div><\/div><div id=\"field_11_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_11_4\" ><label class='gfield_label gform-field-label' for='input_11_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_11_4' type='email' value='' class='large' tabindex='55'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_11_10\" 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_11_10\" ><label class='gfield_label gform-field-label' for='input_11_10'>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_10' id='input_11_10' 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_11_11\" 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_11_11\" ><label class='gfield_label gform-field-label' for='input_11_11'>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_11' id='input_11_11' 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_11_12\" 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_11_12\" ><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_11_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_11_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_11_12_1' value='' tabindex='58'   aria-required='true'    \/>\n                                        <label for='input_11_12_1' id='input_11_12_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_11_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_11_12_3' value='' tabindex='59'   aria-required='true'    \/>\n                                    <label for='input_11_12_3' id='input_11_12_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_11_12_4_container' >\n                                        <input type='text' name='input_12.4' id='input_11_12_4' value='' tabindex='61'     aria-required='true'    \/>\n                                        <label for='input_11_12_4' id='input_11_12_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_11_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_11_12_5' value='' tabindex='62'   aria-required='true'    \/>\n                                    <label for='input_11_12_5' id='input_11_12_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_12.6' id='input_11_12_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_11_5\" 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_11_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What are you interested in?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_5'><div class='gchoice gchoice_11_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Assisted Living'  id='choice_11_5_1' tabindex='63'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_1' id='label_11_5_1' class='gform-field-label gform-field-label--type-inline'>Assisted Living<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Memory Care'  id='choice_11_5_2' tabindex='64'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_2' id='label_11_5_2' class='gform-field-label gform-field-label--type-inline'>Memory Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Adult Day Program'  id='choice_11_5_3' tabindex='65'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_3' id='label_11_5_3' class='gform-field-label gform-field-label--type-inline'>Adult Day Program<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Home Care'  id='choice_11_5_4' tabindex='66'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_5_4' id='label_11_5_4' class='gform-field-label gform-field-label--type-inline'>Home Care<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_6\" class=\"gfield gfield--type-select gfield--width-full community_select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_6\" ><label class='gfield_label gform-field-label' for='input_11_6'>Select Community of interest<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_11_6' class='large gfield_select' tabindex='67'   aria-required=\"true\" 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_11_7\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_11_7\" ><label class='gfield_label gform-field-label' for='input_11_7'>Comments\/Questions<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_11_7' class='textarea small' tabindex='68'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_14\" 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_11_14\" ><p>Have a worry that prompted your request? Feel free to check any or all of worries below and we\u2019ll be happy to provide a tool to help. <\/p><\/div><fieldset id=\"field_11_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_11_15\" ><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 ' id='input_11_15'><div class='gchoice gchoice_11_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Medications'  id='choice_11_15_1' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_1' id='label_11_15_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_11_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Nutrition\/Fitness'  id='choice_11_15_2' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_2' id='label_11_15_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_11_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='Home Safety'  id='choice_11_15_3' tabindex='71'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_3' id='label_11_15_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_11_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='Social Isolation'  id='choice_11_15_4' tabindex='72'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_4' id='label_11_15_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_11_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Planning'  id='choice_11_15_5' tabindex='73'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_5' id='label_11_15_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_11_15_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.6' type='checkbox'  value='Senior Fraud and Abuse'  id='choice_11_15_6' tabindex='74'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_15_6' id='label_11_15_6' class='gform-field-label gform-field-label--type-inline'>Senior Fraud and Abuse<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_13\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  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