Aging & Adult Services Request for Services

To request services through the LDH Office of Aging and Adult Services, you may call the Louisiana Options in Long-Term Care Hotline at 1-877-456-1146. If you are requesting services on behalf of someone else, please have that person's name, physical/home address and Medicaid number (if applicable) readily available when calling. You may also submit a request for services using the form below, and a staff member will contact you for assistance and further information.

I am requesting information about

(Please select the category that best matches the type of services you are seeking. )

Name

(First)

(Last)

Address

City

State

Zip Code

Phone Number (with area code)

E-mail Address

I am requesting services on behalf of

Myself

Someone else

(If you are requesting on behalf of someone else, please have that person's name, address and Medicaid number, if applicable, available when speaking with staff.)

Additional Information

(Please provide any additional details on the types of services you are requesting so staff may better assist you. )

Accessibility