Please do not use this form to submit a Protective Services (Elder Abuse) report or to submit HIPAA protected data about any person. Protective Services reports may be submitted online at https://hssmaprod.wellsky.com/intake/.
If you need to submit HIPAA protected information to SeniorCare, please use the form located at https://hipaa.jotform.com/220186252264047.
HIPAA protected information is any personal or medical information about a SeniorCare consumer or prospective consumer.