CareSource™ - CareSource Life Services® Request Info

If you want to know more about CareSource Life Services, please fill out this form. You can choose how you get information from us. There is no obligation to enroll

You also can reach us at 1-844-607-2828 or by email at LifeServicesGeorgia@CareSource.com. We are open Monday through Friday, 8 a.m. – 5 p.m. We look forward to hearing from you!

First Name:

Last Name:

Member ID:

Address:

City:

State:

ZIP Code:

County:

Phone Number:

Email:

I am interested in CareSource Life Services as a:

CareSource Member Employer Community Organization

I would like to receive email from CareSource.
I would like a CareSource representative to call me.
I would like to receive text messages from CareSource (Check the box for authorization).

Text Communication Consent Authorization:
I authorize CareSource to communicate with me via SMS text messaging on the phone number listed above.

I agree to notify CareSource if I change my phone number.
I acknowledge and understand that text messages that are sent and received will be unencrypted and that communicating by text can never be completely private or secure.
I understand standard text messaging rates and fees from my mobile carrier may apply.
I understand that I am not required to consent to the matters herein as a condition of receiving CareSource benefits and services.
I understand that I can revoke my consent at any time by contacting CareSource Member Services department at 1-855-202-0729 (TTY: 711).

I am interested in learning more about CareSource Life Services programs for (Check all that apply):

This is NOT an Enrollment Application

GA-MED-M-456688a DCH Approved: 11/05/2024