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Participant Application

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We would love for you to be a part of our community. Participants at Keystone are as important to us as they are to you. Complete the application below or download a PDF copy, complete it, and deliver it to Keystone. 

After completing the application, please print the Medical Examination Form and have it completed by the potential participants physician. The physician's office can fax (865-483-4391) the completed form directly to Keystone. Please print, complete, and sign the Medication Form and the Release Form

After submitting your application online or in person, please call the Keystone office and together we will schedule an assessment visit. Please allow one hour for the assessment. At that time the applicant will enter the program while a member of the Keystone staff and the caregiver complete the application process. Once the assessment has been completed, a start date can be determined and the participant is enrolled in Keystone Adult Day Program. If you have any questions about the application and admission process, please call or email us.​

Application Forms

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