Accepting new clients

Start a referral conversation.

Individuals, families, guardians, SSAs, support coordinators and community partners can use this page to request a callback about services and availability.

What happens next

Submit a callback request

Share basic contact information and the service of interest.

Talk with our team

We discuss location, scheduling needs, goals and current availability.

Coordinate with the support team

If the service is a fit, we work with the appropriate people to plan next steps.

Prefer to call?
380-272-8616

Privacy reminder: Use this form only to prepare an initial-contact email. Do not include medical records, diagnoses, Social Security or Medicaid numbers, financial information, passwords, identification documents or other confidential information. Fields marked required must be completed.

Your name

Phone

County

Service of interest

Best time to contact you

How can we help?Keep your message brief and non-confidential.

Submitting this form opens your email application. Review the recipient and message before sending. Ordinary email may not be secure; call 380-272-8616 if you need guidance about sharing additional information.

Referral privacy

Please use the website only to request initial contact. Do not include protected health information, detailed diagnoses, Medicaid or Social Security numbers, medical records or other confidential documents. Our team can explain the appropriate secure process for any additional information that may be needed.