NEW Contact Us Form

First Name *

Last Name *

Phone *

Email *

Which US State do you (or the person you are inquiring for) reside in? *

You have selected a state where PPL offers a personalized call back. Please confirm your preferred call back number below. *

Are you interested in general information about PPL, or are you in personalized program information for options within your state? *

You selected 'Other' for the state you are inquiring about. We're currently do not offer services outside of the states listed above, but encourage you to explore these resources for program options and information on where to find services in your area. To see this information, click the 'Yes' checkbox below.

Are you (or the person you are inquiring for) currently on Medicaid? *

You selected 'No' or 'Not sure' if you or the person you are inquiring about is currently on Medicaid (or Medicaid eligible). We're currently do not offer services to non-Medicaid users, but encourage you to check out the following Medicaid resources if you are interested in pursing one of our self-directed home care programs. To see this information, click the 'Yes' checkbox below.

If you are on Medicaid, are you (or the person you are inquiring for) on a Waiver?

If you (of the person you're inquiring for) have an ID number that you know is affiliated with PPL, please write it below.

Do you know the name of your (or the person you are inquiring for's) Service or Supports Coordinator. (They may also be called a "Case Manager".) *

If you know that you (or the person you are inquiring for) are not going to qualify for Medicaid, are you looking to hire a personal care attendant and pay out of pocket? *

Thank you for helping us understand your personal situation and narrow down your options for self-direction care, please write any remaining question(s) and/or a brief description of the assistance you may need. *

I agree that I have not included any Personally Identifiable Information or protected health information in the comment field. *

Consent for storing submitted data *

Yes, I give permission to store and process my data

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NEW Contact Us Form

Please complete the form below with any questions or queries you might have regarding PPL or to learn more about how to begin a self-directed home care journey.

Contact Us