Please answer the 5 following questions.  It should only take 2-3 minutes of your time. Thank you.

* 1. Caregiver's first name

* 2. Cell phone number with area code

* 3. The Oklahoma town where you reside.

* 4. Will the loss of your loved one's In-Home Support Waiver mean they can no longer be cared for safely in your home?

* 5. If we lose the In-Home Support Waiver, we will be forced to move our loved one into a nursing home or similar facility.

You may be contacted by the Oklahoma Disability Law Center, but this in no way obligates you financially or your time. Not all respondents will be contacted. You may learn more by calling our office at (800) 880-7755.