1-on-1 Care Services1-on-1 Care ServicesRequest Care

Request care

The right support starts with listening.

Tell us what would make life safer, easier, and more connected at home. Our intake team will guide you through the next step.

No pressure. Just a conversation.

You do not need to have everything figured out.

Whether care is needed immediately or you are planning ahead, this short form helps us understand who needs support, where care is needed, and how to reach you.

  • Personalized care planning
  • Statewide South Carolina coverage
  • Support for children, adults, seniors, and veterans
  • Multiple payment and eligibility pathways

Begin here

Care request form

This is an initial contact form—not an admission or medical record. Please do not include sensitive medical or financial information.

01 — Contact information

02 — Care needs

Services being considered