Refer A Loved One

Referral Form

Please use the form below to refer your loved one and we’ll get back to you as soon as possible.

Referrer's Name (Required)

Email Address (Required)

Phone Number (Required)

Do we have Permission to call you?

Person in Need of Care (Required)

Relationship

Referred Person Phone Number (Required)

Referred Person Email Address

City and State Residence (If known)

Type of Care Needed (If known)

Your Message (Required)

I confirm that I have the referred individual’s consent to share their information for the purpose of care coordination.

About Referrals

Rivers of Hope aims to serve all individuals and families who require our services. So, if you have someone in mind who can benefit from our services, provide us with the opportunity to serve them.

POLICY ON REFERRAL AND WAIT LIST
Currently, Rivers of Hope does not have wait list.

These organization will accept referrals from individual, physicians and other community partnership agencies. The organization will in the future accept persons who can private pay for their services. In the event that there is a wait list it would be retained by the referring agencies.

Procedure

Rivers of Hope will receive referrals from a variety of sources
The referral sources maintain a wait list and provides the referrals based on their criteria for a person’s need
The referral will go to the executive director or in her absence to the appointed case manager
The referral will be reviewed to determine if it meets the criteria for entry into the program
The executive director or case manager will determine if appropriate staffing can be provided
If all criteria are met, the referral will be accepted, and a start date determined
Executive director or case manager will notify the referral source that the individual has been accepted into the program at the start date for services to begin
If the individual does not meet criteria for acceptance the executive director or case manager will follow the steps in the notification of the persons served, legally responsible person if appropriate, referral source and all other stakeholders as necessary

Refer A Loved One

Referral Form

Please use the form below to refer your loved one and we’ll get back to you as soon as possible.

About Referrals

Procedure

Contacts

Services

Social Links

Awards