Service Needs Checklist

If you or someone you know is being physically or emotionally abused, neglected, or financially exploited, DO NOT fill out this checklist – instead, please call the PCA Helpline immediately: 215-765-9040 or toll-free (from outside Philadelphia) 888-482-9060, 24 hours a day, seven days a week.

The information you provide is strictly confidential and will not be shared with anyone, without your express permission. This checklist is designed to help you determine what kinds of services are available that could help you, or the person you are caring for, achieve optimum levels of independence.

When you have completed the checklist and submit your information, you will receive recommendations and information about related resources. You may also choose to have it emailed to you.

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