Book An Appointment — Grace Healthcare Services, Inc.

In need of services?

Complete the following questionnaire if you have a family member or individual on your caseload in need of COMP waiver services. Someone will reach out to you as soon as possible.

Name

First Name

Last Name

Subject

What is your relationship to the individual in need of services?

Brief Description of Service Need

Please provide the name and any details regarding requested services. Please include as much as possible in regard to the need level of the individual. For example, assistance with ADLs, non-verbal, behavioral issues, etc.