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NWICA ONLINE REFERRAL FORM (2021)

News and Annoucements

 

MAKE A REFERRAL

Refer a patient, a loved one or yourself for Options Counseling Services with our NEW online request/referral form.

By filling out thsi form, you can request a phone cll appointment with a qualified, long term care options counselor in our Aging & Disability Resource Center. There is never a fee for this confindetial service that helps older adults, people with disabiliteis and caregivers think through the multiplicity of options for long term supports and services.

NWICA serves Lake, Porter, Jasper, Newton, Pulaksi, Starke, and LaPorte (WIC, HCVP) counties in northwest Indiana. When the individual needing assistance lives outsie of these counties, please visit one of our partner agencies at: in.gov/fssa/inconnectalliance

If you are seeking information on behalf of someone else, please notify the individual that you are making this referral and that NWICA will contact them by phone. Individuals have the right to refuse any and all type of service, including NWICA's intitial phone assessment. NWICA's services are provided without regard to race, age, color, religion, sex, sexual orientation, gender identity and/or expression, disability, national origin, ancestry, or status as a veteran.

In the event that NWICA has attempted to make contact without success, it will be the responsiblitiy of that person to contact NWICA through the ADRC at 219-794-1829 or 1-800-826-7871.