Refer Someone

Please select one of the following options:

Please note these forms are not for Utility Assistance or Home Weatherization services: those requests must first go through United Way's 2-1-1 Helpline. Those with a disconnect notice or a life-threatening situation caused by the lack of electricity, please call: 713-956-7456.

Choose the Professional Referral Form to request non-medical care services (excluding utility assistance or weatherization), if you are a medical professional, discharge planner, or other care professional.

Choose the Home Health Care Referral Form to request nursing and rehabilitation services, if you are a physician, discharge planner, or other care professional.

Choose the Individual Referral Form if you are referring a family member or friend.

To speak with an Access and Information Counselor about your referral, please call 713-685-6577.

For Utility Assistance or Home Weatherization services, please call United Way's 2-1-1 Helpline to start the application process.

Thank you for your referral!