Please Note: This form must be completed by a medical center or provider staff member. Once you submit, the form is sent automatically to SECU Family House by e-mail.
SECU Family House Eligibility Requirements:
- Patient must be 18 years of age or older.
- Guests must have a permanent residence outside Forsyth County, NC.
- Referred guests are asked to pay a nightly fee of $40. Financial Assistance may be available for a reduced rate and will be determined by our staff.
- We allow one room per patient with up to four people. Rooms feature two queen beds and a private bath.