Call us: (651) 237-3149

For Case Managers

DHS Waiver Referral

Refer a client for waiver-funded home modifications. Complete the form below and our team will follow up to schedule an assessment and provide comparable bids. Questions? Call us at (651) 237-3149.

Client Information
Contact Person & Property Owner (if different from client)
Case Manager & Financial Coordinator
Waiver & Funding
DHS Waiver — choose any that apply *
Does the client have a spendown? *
Will the project use CDCS funding? *

If CDCS funding is used, please provide the FMS (Financial Management Services) contact:

Modification Needed
Attach plans, assessments, or photos (optional)

PDFs and images work best. Large files may be slow to upload.

Consent

We'll follow up within one business day. Urgent? Call (651) 237-3149.