If you are in need of assistance, complete the online intake form below to connect with our team. 

Our services are reserved for Mississippians with disabilities. Once you have filled out the form below, click “Submit” and DRMS will contact you. Submissions are monitored only during normal business hours; we strive to respond as soon as possible, but please allow for four (4) business days of processing time. DRMS is unable to provide legal and/or advocacy services to every service request, but we are committed to providing referrals, information, and technical assistance as available. 

DRMS collects demographic information per federal funding reporting requirements. You may decline to answer these questions. While you are not required to provide certain contact information to submit the form, we ask that you provide as much information as possible so that we may best reach you and provide assistance. If you are completing the form on behalf of an individual with disabilities, please complete the bottom portion of the form with your information. 

DRMS’ intake process is confidential; however, we ask that you do not include any sensitive information, such as your Social Security Number or Medicaid number within this submission. This form of communication does not create an attorney-client relationship between the submitter and Disability Rights Mississippi.