The Arc of the Triangle Information and Resources Questionnaire
The Arc of the Triangle wants to assist you in finding support and answers. Please fill out the following questions and we will do our best to get back to you within 3 business days.
Reason For Contacting The Arc of the Triangle
Moving to North Carolina for another state/country
Individual is facing transitions
Name of Person Contacting The Arc
Relationship to Individual
Contact Information - Email
Contact Information - Phone
Contact Information - Mailing Address
Contacting on Behalf of (Individual's Name or Initials)
Individual's Diagnosis(es) (check all that apply)
Traumatic Brain Injury
Date of Birth
Is the individual currently receiving Medicaid?
If yes, from what county, state
We need information on (check all that apply)
Services (Innovations, Medicaid, Personal Care, Respite, Community Based Services)
Leisure and Recreational
Special Needs Financial Planning
What else would you like us to know?
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