Mail Response Form

We encourage you to use our Mail Response Form to request assistance, comment on our website, programs or services, or to receive any brochures and publications by mail.

If you are requesting information to be mailed, please provide your name and complete postal address. If you would like a personal response to a question or comment, please provide your postal and email addresses, as well as a daytime telephone number.

Once you have completed your request, use the SUBMIT button at the bottom of the page to send your message.

First Name:

Last Name:

Sex: (optional)

 Male   Female

Age:

Email Address:

Postal Street Address:

City

County (MD Residents only)

State

Zip Code

Telephone Number


I would like to request the following information:

Everybody Has Questions About Aging (Senior Information & Assistance)

SHIP - Senior Health Insurance Program

Maryland Long Term Care Ombudsman

SMP - Senior Medicare Patrol

Five Wishes Document

Continuing Care Retirement Community Consumer Packet

Continuing Care Retirement Community Developer Packet

Continuing Care At Home Consumer Packet

Continuing Care At Home Developer Packet

Senior Nutrition Program Fact Sheet

Senior Care Program Fact Sheet

Questions and Answers About Programs and Services for Older Marylanders

SHIP MATES Volunteer Program

Mediation Services For Older Adults

Older Workers Are Good For Business

The F.I.L.E

Join Other Active Seniors

Lifesaving Medical Information Card

Low Cost Legal Help for Seniors

Provider Application: Medicaid Waiver (Client Applications for the Medicaid Waiver may only be obtained by contacting the local Senior Information & Assistance Office

Please add me to the Department's mailing list (for newsletters, invitations, etc.)

To request any other brochures or publications, or to submit a question or comment, please use the space below:

 

Thank you for your time