Member Care Assistance Request Member Care Assistance Request To request assistance, please fill out the form below with as much information as you want to provide. Once you complete the form, click on submit and your request will be sent to the Member Care team.Name *Email *Phone *Best Contact Method *PhoneTextEmailNeed (check all that apply) Prayer PartnerGroceries/MedicinesVisits/Check-insYard WorkNotify of Illness/Surgery/DeathBabysittingMinor RepairHospital / Nursing Home VisitMove-in HelpHelp with AppointmentsOtherAdditional details about the need VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: