Residence Inquiry Form

For information about admission to the Los Angeles Jewish Home, please fill out the form below.

You may fax your completed form to 818.343.3718 or mail it to Admissions Department, Los Angeles Jewish Home, 7150 Tampa Avenue, Reseda, CA 91355. For general inquiries, please contact us at 818.774.3306 or by email at admissions@jha.org. For more detailed inquiries, you may also contact the Admissions Nurse at 818.774.3062.

(All fields with bold labels are required.)

Contact Info

Information Requested
Services Offered
Admission
Long Term Care
Short Term Care
Independent Living
Assisted Living
Residential Care
Skilled Nursing Care
Alzheimer's and Dementia Care
Lisa and Ernest Auerbach Behavioral Health Center (Behavioral/Mental Health Issues)
Acute Psychiatric Hospital
Skirball Hospice Care
Other:

Yourself:
Other:

Immediate Need
Future Need

Would you like to schedule an appointment or a tour of our facilities?


between 9 am and 11 am
between 1pm and 5 pm