Don’t have an immediate care need?

Get the right help for your situation.

Although Senior Care Counsel primarily serves individuals with an immediate long-term care need, our network of specialists is equipped to help with a wide variety of situations.

Please provide some more details about your situation below, and a member of our team will be in touch.

"*" indicates required fields

Your Information

Name*

First Last

Email*

Phone

State*

Zip Code*

Preferred Contact Method

Preferred Contact Time

Who is in need of long-term care planning assistance?

Explain your relationship to the individual needing care

Please provide a detailed explanation about your situation and why you're seeking help. This information will help us pair you with a specialist who can most effectively help with your situation.*

Your Loved One's Information

Your Client's Information

Name

First Last

Date of Birth*

Marital Status*

State*

Zip Code*

Estimated Monthly Income*

Are they currently receiving long-term care?*

How soon do you estimate they will require long-term care?*

Please explain their current care situation*