Referrals & intake

Start a referral

For families, Coordinators of Community Services, case managers and discharge planners. Takes about two minutes, and we respond within one business day.

About you

Your full name (required)

Your role (required)

This tells us who should call you back.

Organization (optional)

Agency, hospital or program, if you are referring in a professional capacity.

Email address (required)

Phone number (required)

How should we reach you first?

Phone Email

What you need

County where services are needed (required)

Services you are interested in (required)

Choose as many as apply.

Funding source (required)

“Not sure yet” is a perfectly good answer.

When are services needed? (optional)

Anything else we should know? (optional)

Please do not include health information — no names, dates of birth, diagnoses or Medicaid numbers. We will take those details securely by phone.

This form is deliberately designed not to collect personal health information, which is why it asks about you rather than about the person needing support. See our privacy notice.

We respond within one business day. Prefer to talk? Call (301) 996-0992.

Prefer to talk?

Some referrals are easier explained than typed. Call us directly.

(301) 996-0992 (301) 928-8242 [email protected]

What happens next

Within one business day — we acknowledge your inquiry and make contact.
A conversation — with the person, their family and their Coordinator of Community Services.
A review — of the person-centered plan and any nursing needs.
A visit — where residential support is being considered, before anyone commits.
A straight answer — whether we can meet the need, and when we could start.

Why we ask so little

A web form is not a secure channel for health information. This one asks about you, not about the person needing support, so nothing sensitive travels over email. We take client details securely by phone once we are in touch.