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Request for Services

How to get help

To get help from Disability Rights Montana, you can call our our office, drop by the office, or complete and submit the Request fo Services Form below.

If you would like to call and talk to one of our advocates, please call us at (406) 449-2344, or toll-free at (800) 245-4743.  If an advocate is unavailable when you contact Disability Rights Montana, your call will be returned no later than the following business day.

You can also stop by our office and ask to speak with an advocate. Our office is open 8:00 a.m. to 5:00 p.m. Monday through Friday. We are located at 1022 Chestnut Street in Helena, near the intersection of Montana Avenue and Chestnut Street. 

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The third way to contact an advocate with your questions or to request services, is to complete the following form.  An advocate will get back to you.

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If you need immediate assistance, have a deadline, or are dealing with a critical issue, please call us directly at (406) 449-2344, or toll-free at (800) 245-4743.

REQUEST FOR SERVICES FORM

In order to submit this form, a contact name must be given.  If you would like to remain anonymous, you may use a different name; we just need some way to reach you after you leave us a request for services. 

Note: required fields are in red.  
Contact First Name:
Contact Last Name:
Email: or Telephone Number:
Mailing Address:
City:
State: 
Zip: 
Are you asking for assistance for yourself or for another person needing services?
 
Please indicate what disability you or the person requesting assistance has.  Check all that apply:
Absence of extremities ADD/ADHD All other disabilities
Autism Auto-immune (non-AIDS/HIV) Bi-polar
Blindness (both eyes) Cancer, all types Cardiopulmonary diseases or disorders
Cerebral palsy Congenital amputee Cystic fibrosis
Deaf and blind Deafness Diabetes
Digestive disorders Down Syndrome Emotional disturbance
Epilepsy Fetal Alcohol Syndrome Fibromyalgia
Fragile X Genitourinary conditions Hard of hearing/Hearing impaired (not deaf)
Heart and other circulatory conditions HIV/AIDS Intellectual disabilities
Juvenile diabetes Learning disabilities Mental illness
Multiple sclerosis Muscular distrophy Muscular/skeletal impairment
Neurological disorders None Other
Other emotional/behavioral Other head injuries Other intellectual
Other physical/orthopedic impairments Respiratory disorders Schizophrenia
Skin conditions Specific Learning Disabilities (SLD) Speech impairments
Spina bifida Substance abuse (drug/alcohol) Tourette Syndrome
Traumatic Brain Injury (TBI) Turners Syndrome Unknown
Visual impairment (not blind)    
   
Age:  Gender:  Male Female  
 

Are there any special needs or accomodations, in order for us to assist you?  If so, please explain:

What is the best way for us to reach you?  Email Phone Regular Mail
What is the best time to reach you by phone? 
What would you like us to help you with?  Please describe the problem or issue, and what you would like us to do to assist you.