Southern Illinois Healthcare welcomes you to the SIH Senior Advantage program. Simply complete the following enrollment form to take advantage of this FREE program.

About You                                                 = required field First Name: M.I. Last Name: Date of Birth: SSN: Gender: Male Female   Marital Status: Single Married Divorced Widowed Where You Live Address: City: State: Zip: County: Home Phone: E-Mail Address:   Your Physician Is On Staff At   Ferrell Hospital Herrin Hospital Memorial Hospital of Carbondale St. Joseph Memorial Hospital Other Enter Other: How Did You Hear About SIH Senior Advantage?   Brochure Newspaper Health Fair Event Physician Office Family Member Lecture/Screening Friend Hospital Other Enter Other: Your Interests What areas would you like SIH Senior Advantage to develop?   Health Risk Assessments Medication Counseling Physician Referral Assistance Exercise Programs Senior Housing Information Your Comments