Pre-Application

100 Silver Bluff Drive, Canton, NC 28716 * 877-902-4748 * 828-648-2044


	*Family Serving Families Since 1962......*












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Silver Bluff Village
Pre Admission Application

Complete pre-application form is available by clicking the link below and printing the form. The form can be mailed or faxed to Silver Bluff Village.


	Upon receipt of the completed Pre-Admission Application you will be requested to give consent to the applicant's attending physician for the release of medical information to Silver Bluff Village. These materials will be reviewed and the one submitting the application will be advised as to the applicant's status for admission to Silver Bluff Village.


	Full Pre Admission Application (PDF)


	Or fill in the information below and a complete information package will be mailed to the address provided.


	Note: Required fields are in BLUE


	Your Name:


	E-Mai: l


	Applicant's Name:


	Permanent Address:


	County/State of Residence:


	County/State of Origin:

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