Person Completing the form
Referred Individual or Family
Permanent Address *
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Disclaimer

The Care Referral will be reviewed by a member of the intake department at Hoosier Families Inc., who will either follow up directly with the referred individual or family. With the intention to protect the privacy of the referred person, please understand the referring party may not learn the outcome of the Care Referral submission.

Get Immediate Help in a Crisis

Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.

988 Suicide & Crisis Lifeline

Call or text 988;
Use Lifeline Chat on the web (English only)
The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 to connect with a trained crisis counselor.

Veterans Crisis Line

Use Veterans Crisis Chat on the web
The Veterans Crisis Line is a free, confidential resource that connects veterans 24 hours a day, 7 days a week with a trained responder. The service is available to all veterans and those who support them, even if they are not registered with the VA or enrolled in VA healthcare.

Disaster Distress Helpline

Call or text 1-800-985-5990
The disaster distress helpline provides immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. The helpline is free, multilingual, confidential, and available 24 hours a day, 7 days a week.

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