We help seniors resolve legal & long-term care problems

Contact Ohio SMP form

First Name (required)

Last Name (required)

Your relationship to the Medicare beneficiary (required)

Your Contact Information

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Your Phone Number (The best number to reach you Monday-Friday, 8:30 a.m.-4:30 p.m.) (required)

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Please provide a brief description of your concern in the space below.
For your protection, please DO NOT include private or sensitive information (medical history, date of birth, Social Security number, Medicare number, Medicaid number or other confidential details).


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