Please fill out the form below and be sure to indicate in the comments box the type of service or services you need.

If the request is for you, we need to know what city and state you live in and we need contact information.  If you are requesting services in another state and city for a loved one, we need that service area as well. None of the other information fields are mandatory and no one will have access to your information except the specialist we give it to.

We respect your privacy. We will never give or sell your contact information to any entity.

Disclaimer: The sole purpose of this service is to assist you in contacting long term care providers or advisors in your area who may be helpful to you. There is no charge to you for using this service. Members of the National Care Planning Council have agreed to abide by an ethical code of conduct. We trust that Council members or anyone else we refer you to will treat you in an honest, fair and equitable manner. We do not verify the background or business practice of our referrals and it is up to you to determine for yourself the integrity of any provider we refer you to. We are not responsible if your experience with any of our referrals is not satisfactory.