- 313-922-2278
- info@yesyoucan2.com
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Detroit Metro Area | Oakland | Wayne | Macomb | Kent | Jackson
26677 W 12 Mile Rd.
Southfield, MI 48034
info@yesyoucan2.com
Phone: 313-922-2278
Ready to Get Started?
Please download, complete, and fax the forms below to 855-287-5729.
Adult Services Application
The client must complete and sign a DHS Adult Services Application form to receive home help services. An authorized representative or another person acting for the client may sign the form if the client is either:
- Incapacitated
- Has a court-appointed guardian
A client unable to write may sign with an X, witnessed by one other person (for example, a relative or department staff).
Medical Needs Form
The Medical Needs form must be signed and dated by a medical professional certifying a medical need for personal care services.
The medical professional must be an enrolled Medicaid provider and hold one of the following professional licenses:
- Physician (MD or DO)
- Physician Assistant
- Nurse Practitioner
- Occupational Therapist
- Physical Therapist