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 in long-term care facility ministry for several years. I have never seen a better facility than Ft. Walton Rehabilitation Center, it is clean and the staff and residents enjoy each other’s company. I have seen staff sing to residents, pray with residents, and genuinely care for our precious residents and each other. The corporate management team is just a phone call away and care about our staff and residents. I am proud to be a part of the Southern Healthcare Management family and Ft Walton Rehabilitation Center. Great place to be!
Michael Blue
google
This is an extremely nice facility that is well run and very well kept. I was amazed at how attentive the staff and management are to every detail. If you or a loved one is in need of acute rehab or long term care I would HIGHLY recommend this facility.
Jeffrey Worman
google

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