Intake Form
Submit a Referral
Refer a client for any of our licensed services. Our intake team reviews every submission and responds within one business day.
Heard back from us before your next meeting
Client details shared only with our intake team
Only see fields relevant to the service you need
* Required fields. Select a service first — additional fields appear for Employment and Respite referrals.
Next Steps
Your Referral in Three Steps
From submission to service — here's exactly what to expect after you hit submit.
01
Confirmation sent to referrerReferral Received
Your submission is logged immediately and routed to our intake coordinator for review.
02
Response within 1 business dayEligibility Review
Our team verifies service fit, funding authorization, and availability — typically within one business day.
03
Direct contact to confirm next stepsIntake & Onboarding
We reach out to the referrer and client to schedule an intake meeting and begin the onboarding process.
Prefer to submit by phone?
Our intake team is available Monday–Friday, 9am–5pm CT.