Prairie Winds Senior and Assisted Living Waitlist

Please complete the form below to be added to our waitlist for the Prairie Winds Senior and Assisted Living. Please note that your registration will not be complete until a $100 deposit is received by Madison Healthcare Services. Deposits may be dropped off or mailed to 900 Second Ave, Madison, MN 56256.

Prairie Winds Waitlist

Name(Required)

First Last

Phone(Required)

Contact Person

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Unit/Suite Preference

One Bedroom

One Bedroom + Den

Two Bedroom

Assisted Living/Personal Care Services - I or my spouse are interested in more information on personal care services available

Yes

Not at this time

Prairie Winds Waitlist

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