Please complete this form to enroll you or your family member in Velma's support services. All information you provide is kept confidential and will never be shared with third parties without your permission.

Once we’ve reviewed your information, we’ll reach out to schedule a brief 15-minute introductory call to walk through the care plan together and answer any questions.

To make sure you don’t miss our message, please save our phone number (917) 967-4292 in your contacts so you can receive texts or calls from us.