MLTSS Interest Survey

Name*
First Last
Phone
Email
What is the best way to contact you?*
- Phone
- Email
Are you a user of services (consumer) or an attendant (caregiver)?
- Consumer
- Caregiver
If you are a consumer, do you know when your next assessment is due?
How can we assist you in regard to MLTSS?*

1432 Wilkins Rd. | Erie, PA 16505

Office hours: 8:30 AM to 4:30 PM Monday through Friday

VOICES FOR INDEPENDENCE DOES NOT DISCRIMINATE IN THEIR HIRING PRACTICE; ON THE BASIS OF RACE, CREED, COLOR, ETHNICITY, NATIONAL ORIGIN, RELIGION, SEX, SEXUAL ORIENTATION, GENDER EXPRESSION, AGE, HEIGHT, WEIGHT, PHYSICAL OR MENTAL ABILITY, VETERAN STATUS, MILITARY OBLIGATIONS, oR MARITAL STATUS.