Skip to content
Call the Helpline:
1-800-963-5337
About Us
Accountability, Data & Impact
Advisory Council
Board of Directors
Services
Information & Access
Caregiver Support
In-Home & Community Support
Nutrition & Wellness
Get Help
Get Involved
Donate
Join Our team
Volunteer
Our Network
Events
All Events
Advisory Council Meetings
Board of Directors Meetings
News & Stories
About Us
Accountability, Data & Impact
Advisory Council
Board of Directors
Services
Information & Access
Caregiver Support
In-Home & Community Support
Nutrition & Wellness
Get Help
Get Involved
Donate
Join Our team
Volunteer
Our Network
Events
All Events
Advisory Council Meetings
Board of Directors Meetings
News & Stories
Donate
Contact The Helpline
Contact the Helpline
First Name
*
Last Name
*
Email
*
Phone Number
Mobile Number
Please choose one:
I agree to receive SMS messages
I do not agree to receive SMS messages
Age of individual in need of assistance
County of Residence of Individual in Need: required
*
I am looking for information or assistance on:
Caregiver information or support
Community resources for seniors or disabled adults – bathing/personal care
Community resources for seniors or disabled adults – food/meals
Community resources for seniors or disabled adults – homemaker
Community resources for seniors or disabled adults –housing/ALF
Community resources for seniors or disabled adults – Legal assistance
Community resources for seniors or disabled adults – Medical resources
Community resources for seniors or disabled adults –Mental Health/Counseling
Community resources for seniors or disabled adults –Transportation
Community resources for seniors or disabled adults –Utility Bill assistance
Financial assistance
Medicare information and/or prescription assistance (SHINE)
Screening for government funded programs to assist seniors
Any additional information we should know:
(For privacy reasons, please do not include any sensitive health information on this form)
Submit
If you are human, leave this field blank.