Intake

Refer someone, or just ask us a question.

Whether you are a family member, a service coordinator, a case manager, or a guardian — this form reaches our intake team directly. There is no cost and no obligation, and we answer every message within one business day.

About You

I am…

Your name

Organization If you are referring professionally

Phone

Best way and time to reach you

About the Person Please do not include medical details or diagnoses here

Person's first name Or initials, if you prefer

Age

City they live in now

Are they enrolled in HCS today?

What are you interested in? Check everything that applies.

Group home placement

Host home placement

Support at home

Skills & socialization

Respite

Not sure yet

How can we help? Tell us what you need in your own words. Please leave out diagnoses, medications, and other medical details — we will gather those securely once we connect.

How soon do you need services?

This form is not monitored around the clock. If someone is in immediate danger, call 911.