Pre-Admission Form



Please provide the following information and hit the 'submit' button. If you have any questions or need any assistance, please call our admission staff at 813-261-5500.

  • Demographic Information

  • Date Format: MM slash DD slash YYYY
  • Financial Information

  • Reason for Skilled Nursing Center Placement

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Contact Information

  • Demographic Information

  • Date Format: MM slash DD slash YYYY
  • Financial Information

  • Reason for Skilled Nursing Center Placement

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Contact Information

REVIEWS

I have been employee for rocky mount rehab for 22 years. I can truly say enjoy my job, and the staff here is great. We work hard to provide the best care, and a loving environment for our residents.
Theresa Thomas
google
I'm a current employee at Rocky Mount Rehab, and I enjoy my job, coworkers and our sweet residents. This is a clean facility, and the nursing/cna staff are caring people, who do their best to provide care as efficiently and thoroughly as possible. My own father has been a resident here on more than one occasion and has been very happy here. He has recommended the facility to others several times.
Jennie Daughtridge
google

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