PPL

HCBS 2022 Appointment Request Form

Making Self-Directed Home Care Easier For All
HCBS 2022 Appointment Request Form

Please complete the form below and a PPL agent with the HCBS conferences will contact you to schedule your appointment with a PPL representative.

Note: Please keep in mind that communications via email over the internet are secure to the best of our ability. Please do not include any Personal Identifying information such as your birth date, SSN, or personal medical information in the form submission below. Communications via our publicpartnerships.com website is only a precursor to the communications you may have with our Customer Service Agents in the future.

HCBS 2022 Appointment Request Form

First Name *

Last Name *

I would like to set an appointment. *

Questions or information to be reviewed during this session. *

Consent for storing submitted data *

Yes, I give permission to store and process my data