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How to Apply

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

Adult Day Service Enquiry Form

The programs offered by Seniors Life Enhancement Centres are designed for the Mississauga Halton LHIN population 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 applying to be referred to?* 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).
Not sure

Name of person enquiring*

Organization you are affiliated with – if applicable

Your Phone Number*

Your Email Address*

Your Relationship To Client

Potential Client's Name*

Name of Primary Caregiver

Primary Caregiver Phone Number

Primary Caregiver Email

Primary Caregiver Relationship To Client

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

Are you currently receiving services coordinated by the Community Care Access Centre (CCAC)? No Yes

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