Refer someone for services

Use this form to refer an individual for any of our disability support services. Our team will follow up within 2–3 business days.

Referral form

You can submit this form as a family member, case manager, support coordinator, or community professional.

Your information (the person referring)

Your first name *

Your last name *

Your relationship to the individual *

Your phone number *

Your email address *

Organization / agency (if applicable)

About the individual being referred

Individual's first name *

Individual's last name *

Date of birth *

Gender

Current city / county *

Primary diagnosis / disability *

Current living situation *

Services requested

Which services are you interested in? (select all that apply) *

In-home support services Employment support Community-based day support Residential care Host home placement Not sure — need guidance

How urgent is this referral? *

Does the individual currently have a Medicaid waiver or DSPD funding? *

Yes No In process / applying Not sure

Additional information

Please describe the individual's support needs, strengths, and any important background information *

Is there anything else we should know before reaching out?

I have permission to submit this referral and confirm the information provided is accurate to the best of my knowledge. *

✅ Referral submitted! Our team will follow up within 2–3 business days.

♡ Homes For Angels

Youth Adult Services

Person-centered disability services across Utah.

(801) 830-1473 homesforangels@gmail.com Mon–Fri, 9 AM – 3 PM MDT