Illustration of three people celebrating together with colorful confetti and a large red heart above them.

Refer a Client!

We’re so glad you’re here! If you are someone or know someone who could benefit from personalized support and inclusive connection, you’re in the right place. Just fill out the short form below to start the referral process.

Our team will follow up with care, kindness, and next steps because everyone deserves the opportunity to thrive. You should hear from us within a week!

Your Name

First Name

Last Name

Your Relationship to the Potential Client

If you are the potential Client, please write N/A.

Potential Client's Name

First Name

Last Name

Is the client over the age of 18 years old?

* We only work with clients 18 years old and above

Yes

No

Client's Email

Client's Phone Number

(###)

###

####

Client's preferred form of communication:

Phone Call

Email

County that Client lives in:

Washington

Multnomah

Clackamas

Service Coordinator's Name

First Name

Last Name

Service Coordinator's Email

Who is the point of contact?

If their contact information has not been previously listed, please add that here.