Free Consultation

If you or anyone you know is currently in need of the Long Term Care and would like to preserve a lifetime of savings, please send your questions or request your FREE consultation.

Your Name (required)

Your Email (required)

Your Phone Number (required)

Stay Informed
Useful Links
  • http://ahca.myflorida.com/Contact/call_center.shtml
  • http://elderaffairs.state.fl.us/english/cares.php
  • http://www.agingcarefl.org/network/Cares_Unit
  • http://www.blspinellas.org/
  • http://www.dcf.state.fl.us/
  • http://www.seniorlivingonline.com/tampabay/
  • https://secure.ssa.gov/apps6z/BEVE/main.html

Pre-Screening Form

We assure you that all of you personal information disclosed on this form will be kept safe and confidential. Please take a minute to fill this form out, and we will contact you within 24 hours with your Medicaid eligibility.


*Important: Please provide us with accurate contact information so we can relate the pre-screening results to you as soon as possible.

Name
Email
Telephone Number
Applicant's relationship to you
Applicant's age
Applicant's Marital Status
Applicant's health condition
Is Applicant's GROSS monthly income exceeding $2,022?
Is applicant's total of liquid assets exceeding $109, 560 (If married)
Is applicant's total of liquid assets exceeding $2,000 (If single)?
Applicant owns any investment accounts?
Applicant owns any real estate property?
Applicant owns any vehicles?
Applicant owns any LIfe Insurance policies?
Applicant owns any Pre-paid Burial contracts?
Did any transfers of money or gifting occur in the last five years?