PRP Services | Youth & Adults
Share your information to request PRP referral details for yourself or your child.
Welcome to Root & Rise with T!
Interested in learning more about PRP services for yourself or your child? Please complete this brief form, and I’ll follow up with information about the referral process.
PRP supports eligible youth and adults in developing life skills, healthy routines, coping strategies, and greater independence.
Who are you inquiring about?
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Myself
My Child/Teen
Another Adult
Potential Client’s Full Name
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First Name
Last Name
Potential Client’s Age
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Parent/Guardian or Contact Person’s Name
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First Name
Last Name
Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address
example@example.com
Insurance Carrier
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Please Select
Maryland Medicaid
MedStar Family Choice
Priority Partners
Maryland Physicians Care
Wellpoint
UnitedHealthcare Community Plan
CareFirst Community Health Plan
Other
Not Sure
Preferred Contact Method
Phone Call
Text Message
Email
I agree to be contacted regarding my PRP inquiry. I understand that submitting this form does not guarantee eligibility, enrollment, or services.
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I agree
Submit Inquiry
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