Partner Referral

Submit a Referral

Use this form to send a family directly to us. We'll reach out within 1 business day and handle everything from there.

Your Information

Tell us a bit about yourself so we can reach you if needed and introduce ourselves properly to the family.

First Name *

Last Name *

Work Email *

Phone (optional)

Firm / Organization Name *

Role / Title *

How should we identify you when we reach the family? *

e.g., "Your attorney Jane Smith referred you to us" vs. "A professional partner shared your contact"

Tell us about the family you're referring. We'll reach out to them directly and handle the introduction.

Family Contact Name *

The adult child or primary caregiver — not the care recipient.

Family Contact Email *

Brief context (optional but encouraged)

Anything we should know before reaching out — urgency, situation, what prompted the referral.

Has the family been told to expect our outreach? *

YesNoNot sure

Sliding scale pricing for Action Plan? (optional)

If financial hardship may be a barrier, let us know so we can discuss pricing options.

ReducedHardship

We'll confirm receipt by email and follow up with the family within 1 business day.