Seniors Life Enhancement Centre

If you are interested in the services provided by Seniors Life Enhancement Centres please complete the enquiry form below. You will be contacted upon receipt of this Enquiry Form.

The programs available at Seniors Life Enhancement Centres are offered to people living in the Mississauga Halton region who have physical impairments independently or who have Alzheimer’s disease or other cognitive impairments that interfere with their capacity to function. The program offers stimulating, therapeutic, social, and recreational activities that enhance the quality of life of our clients while providing respite and support to caregivers.

Which program are you enquiring about?(*)

This enquiry is for Circle of Friends (adult day service for clients with Alzheimer's disease, dementia and/or other cognitive impairments)
This enquiry is for Gathering Place (adult day service for clients with any of the following: physical disabilities, mild cognitive impairments, frail health)
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Potential Client's Name(*)

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Name of person enquiring(*)

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Your relationship to the client(*)

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Are you the Primary Caregiver?(*)

YES No Invalid Input

Organization you are affiliated with (if applicable)

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Your Phone Number(*)

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Your Email Address(*)

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Name of Primary Caregiver

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Primary Caregiver Relationship To Client

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Primary Caregiver Phone Number

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Primary Caregiver Email Address

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Indicate best time(s) to contact you.

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Please indicate the diagnosis of the client and/or current functioning level.

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Are you currently receiving services coordinated by the Ontario Health at Home and/or Central Registry??

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Name of Case Manager

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Adult Day Service Enquiry Form