Request Help From Senator Moore

Senator Moore takes pride in helping constituents navigate through red tape in government. If Senator Moore can assist you, a family member or friend living in the Second Worcester District with an issue involving a state agency, please complete the form provided below. You may also be interested in viewing the "Helpful Resources" link found on this page.

Please note that issues with Federal Agencies including Social Security, Veterans Affairs, and the Internal Revenue Service (IRS) are best directed to Federal Representatives. You may access their office contact information by clicking here.

STAFF CONTACT: DOREEN GOODRICH

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

I am seeking help for:

Myself

A Family Member

A Friend or Neighbor

Government Agency

Please select the government agency with which you, a family member or friend are experiencing an issue. If the issue pertains to none of the options listed OR multiple agencies, please select "Other" and include the appropriate agency name(s) within your message below. *Please note that a Permission to Share Information (PSI) form is required for all cases involving MassHealth or the Health Connector. Similarly, a release form is required for issues involving the Department of Revenue (DOR). Links to both privacy release forms are available below.

Message

Please briefly describe the issue you, or the person for whom you are advocating, are experiencing.

*FOR MASSHEALTH/HEALTH CONNECTOR ISSUES PLEASE CLICK HERE TO ACCESS THE PERMISSION TO SHARE INFORMATION FORM
*FOR DEPARTMENT OF REVENUE (DOR) ISSUES PLEASE CLICK HERE TO ACCESS THE NECESSARY RELEASE FORM

HELP WITH A GOVERNMENT AGENCY

Request Help From Senator Moore