Let’s talk about support at home.

This general inquiry form is for individuals and families who want to ask about personal care or in-home support services. You do not need to know the exact program name before contacting Val’s.

Not sure which service applies? That’s okay. Tell us what you are looking for. Our office can explain how to begin but does not independently determine eligibility.

Request a callback

Required fields

Please protect your privacy.

This form is for a general inquiry only. Do not submit Social Security numbers, Medicaid identification numbers, insurance cards, medical records, diagnoses, detailed medical history, financial information, passwords, or other sensitive documents.

Contact our office first if you need instructions for sharing protected or confidential information.

Your name *Your relationship to the person needing care *Phone number *Email addressCounty where care is needed *Care is for *Service of interest *When are services needed? *Best time to call *Preferred contact method *Anything general you’d like our team to know? Do not include medical or financial details.

I understand this is a general inquiry form and I should not submit protected health information, sensitive identifiers, or confidential documents. *

Before submitting

This form does not guarantee eligibility, authorization, case acceptance, staffing, or a start date. It does not replace emergency services.

For an emergency, call 911. This form is not monitored for emergency response.

WHAT HAPPENS AFTER YOU SUBMIT

A general inquiry begins the conversation.

1
Your request is received
Val’s receives the general information submitted through this form.
2
The office reviews the inquiry
Staff review the service interest, county, and contact information you provided.
3
A staff member may contact you
The office may reach out to learn more and explain what may follow.
4
Program requirements may follow
Assessment, eligibility, authorization, or referral steps may be required depending on the service or program.
5
Service arrangements are confirmed separately
Services move forward only if applicable requirements are met, Val’s can accept the case, and staffing is available.

WHEN TO CALL INSTEAD

Sometimes a conversation is the better first step.

Consider calling if you need help understanding which service may apply, have a time-sensitive non-emergency inquiry, have a question before submitting, need instructions for sharing sensitive referral information, or simply prefer to speak with the office.

Call (252) 332-2071