Application for Admission

Please fill out the following form to be considered for admission

Blue Cross Blue Shield

Important information concerning the Resident Rights. Does the applicant have any either of the following?:

If yes, whom?
If yes, whom?
If yes, whom?
Person to notify in case of emergency:

Canal View – Houghton County  |  1100 W. Quincy Street, Hancock, MI 49930  |  906.482.5050