Client Change in Circumstances

This page is to report a Change in Client Circumstances only,  such as going to or returning from the hospital, going onto or coming off of rehab, the death of a spouse, or other similar occurrence.

To submit a new Client, to let us know about a change in Client income, or to let us know that we should cease services for a Client, please follow the instruction included with the Service Agreement.

    Your Name (required)

    Your Email Address (required)

    Client's Name (required)

    Description of the Client's change in Circumstances(required)

    You must include:
    Name of the care provider (name of the nursing home, assisted living facility, or home care provider)
    City of the care provider
    Customer name (who has the agreement with Miller Trust Services Company)
    DO NOT INCLUDE any private health or private financial information

    Sorry for the inconvenience, but please prove that you're not a robot.

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