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Request for Service

How to get help

If you live in Montana and are seeking assistance from Disability Rights Montana, please call our office, come to the office in person, or complete and submit the Request for Service Form below.  If you live in another state, please click here to find the Protection and Advocacy system in your state.

If you would like to talk to one of our advocates on the phone, please call us at (406) 449-2344, or toll-free (800) 245-4743. If an advocate is unavailable when you call, please leave your name, phone number, and a brief message and an advocate will return your call no later than the following business day.

If you prefer speaking with an advocate in person, our office is open for walk-ins from 9:00 a.m. to 4:00 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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You can also contact an advocate with your questions or to request services by completing the form below. 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 SERVICE 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.
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