A&A Legacy Care Services Request care

Tell us what would help

Call and you will reach a person. We answer monday to friday, 9:00 am to 5:00 pm, and the on-call line covers everything else. Or send the form below and we will call you.

Call us

(215) 962-8087

Tell us who needs care and roughly what would help. We will tell you whether we cover your area, what care would cost, and how soon we could start. Nothing on that call commits you to anything.

If we miss you, leave a message. We call back the same day.

Or send this instead

Eight questions, all of them multiple choice, about a minute. It tells us enough to come back to you with something useful rather than a call that starts from nothing.

How to reach you

Please tell us your first name.

Please tell us your last name.

Please enter a phone number with at least 10 digits. Any format is fine.

Please enter a complete email address, including the @ and the part after the dot.

Please choose how we should get back to you.

Only if you picked a phone call.

What you are looking for

Pick the closest answer to each. None of it has to be exact, and we will go through it properly on the call.

Please choose who the care is for.

We serve Philadelphia and Montgomery. Ask anyway if you are just outside.

Please choose a county.

What kind of help would be useful?

Check all that apply. Not sure yet is a perfectly good answer.

Please choose roughly how much help you are after.

Please choose roughly when you would like to start.

Sending it

There is nowhere on this form to write a diagnosis, a medication, or a condition, and that is on purpose. We are not set up to hold health information by email, so we take it on the call instead.

We reply within one business day. If you would rather just talk, call (215) 962-8087 and you will reach a person.