Friendship HouseCare begins with a place to stay.

A place to stay, close to care

Request a stay

Tell us about the patient and each person staying. You can send the application now and add guest photo IDs later, before approval. Hospital-stay proof can be added later, before approval.

Fields marked * are required.

Friendship House location

Patient and medical visit

Patient details

Patient contact details (optional)

Fill in these details if you’d like us to contact the patient after they leave the hospital.

For example, (222) 232-3434. An optional +1 country code is allowed.
Include an apartment or unit number, if applicable. You can enter or correct the address yourself.
Enter exactly 5 digits.

Main guest

The main guest receives updates about this application.

Guest details

For example, (222) 232-3434. An optional +1 country code is allowed.
Include an apartment or unit number, if applicable. You can enter or correct the address yourself.
Enter exactly 5 digits.

Anything else we should know?

Available guidelines for Lakewood:

English guidelines Hebrew guidelines Yiddish guidelines

Documents

Guest photo IDs are optional when sending the application. Upload them now or later; staff must check that each ID belongs to its current guest before approval. Hospital-stay proof can be added later, before approval. PDF, JPEG or PNG, up to 5 MB per file.

You can select the same document here or beside the patient or guest. Both controls show the same selection. If the form reloads for a correction, select the files again.