[vc_row full_width=”stretch_row_content_no_spaces” css=”.vc_custom_1621840542790{background-image: url(https://www.assistedhc.com/wp-content/uploads/2021/05/top-image.jpeg?id=1223) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}”][vc_column css=”.vc_custom_1621595666919{background-color: rgba(0,0,0,0.59) !important;*background-color: rgb(0,0,0) !important;}”][trx_sc_title title_style=”default” title_tag=”h3″ title_align=”center” title=”Start The Enrollment Process” class=”type5″][/vc_column][/vc_row][vc_row full_width=”stretch_row” equal_height=”yes” content_placement=”middle” css=”.vc_custom_1621639685099{padding-top: 50px !important;padding-bottom: 50px !important;background-color: #c9e9ff !important;}”][vc_column][vc_row_inner equal_height=”yes” content_placement=”middle” el_class=”w960″][vc_column_inner][vc_column_text el_class=”type9″ css=”.vc_custom_1621853831708{margin-bottom: 20px !important;}”]

Complete the form below, and a representative from Assisted Home Care will contact you to help you enroll in CDPAP.

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Does the patient have Medicaid?
YesNoI don't know
What is your relationship to the patient?
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