Check If Your Loved One Qualifies — It May Be FREE or No Cost

Fill out the form below and our enrollment team will contact you to walk through the eligibility process. It only takes a few minutes.

Eligibility Inquiry Form

Tell us a little about your loved one and we'll help determine if they qualify for adult day care services — often at no cost.

Your Information

Your Name *

Your Phone Number *

Your Email *

Senior's Information

Senior's Name *

Senior's Age *

Does your senior have insurance? *

Yes No Not Sure

Who is the insurance carrier?

Brief Description About Your Loved One

Preferred Contact Method *

Phone Email

Our enrollment team reviews your information within one business day.

We contact you by your preferred method to discuss eligibility and next steps.

If eligible, we guide you through the entire enrollment process — start to finish.

Prefer to talk to someone right now? Call us directly at (904) 400-5020

Your information is kept strictly confidential and is only used to determine eligibility.