Refer someone

Make a referral. Make a difference.

Whether you're a Service Coordinator, a family member, or the individual yourself, this is the first step. We'll follow up to understand the situation and explain what happens next.

Please do not include private client or health information. This form starts a conversation only — no diagnoses, UCI numbers, assessments, or health histories.

You are...

Your name

Relationship to person being referred

Phone

County

Note — no private client or health information

I confirm this message does not contain private client or health information, and I consent to being contacted about this referral.

Thank you.

Your referral has been sent. We'll be in touch soon.