Admissions & Referrals

Start a referral for residential support

Families, social workers, and county case managers can share the person’s current needs, timing, and support goals. Our team will review the inquiry and follow up to discuss fit, next steps, and available care coordination.

651-202-6703 info@healingcareservices.org

Healing Care Services

CRS Referral Inquiry Form

Please share enough information for our team to follow up. Do not include Social Security numbers or highly sensitive medical records in this website form.

Referral submissions are sent to info@healingcareservices.org. A Healing Care team member will follow up by the preferred contact method.

Submitter Information

Submitter full name *Role / agency *Email address *Phone number *Preferred contact method

Applicant Information

Applicant full name *Preferred name Preferred pronouns Date of birth County of financial responsibility *Current living setting

Guardian or Representative

Guardian / representative name Guardian / representative contact

Services and Support NeedsReferral urgency

Services being requested

Community Residential Services245D waiver services

Brief description of the individual’s needs *

Support Plan / CSSP Upload

Upload Support Plan, CSSP, or related referral documentAccepted file types: PDF, Word documents, images, or text files. Maximum size: 10 MB.Choose Support Plan / CSSP file

Electronic Signature

By typing your name and dating this form, you confirm that the information provided is accurate to the best of your knowledge and that Healing Care Services may contact you about this referral.

Electronic signature *Signature date *

I understand this form sends a referral inquiry to Healing Care Services and should not include Social Security numbers or full medical records.