REFERRALS

Refer an Individual to Mukata Health Services.

Thank you for considering Mukata Health Services, LLC. We welcome referrals from individuals, families, case managers, healthcare professionals, and community partners.

Submit a Referral Call Our Team

PEOPLE FIRST

Support Starts With a Conversation.

Our team will review each referral and work with the individual and their support team to determine how we can best meet their needs.

Person-centered support

Respect for individual choice

Focus on independence and dignity

Easy Referral Share the information we need.

Individual Review Every referral is reviewed thoughtfully.

Next Steps Our team will contact you to discuss needs.

REFERRAL INFORMATION

Help Us Understand How We Can Support.

A few key details can help our team understand the referral and determine appropriate next steps.

Respect & Dignity At every step

WHAT WE NEED

Referral Information.

Please provide the following information when submitting a referral. This helps us understand the individual’s situation and respond efficiently.

Individual’s Name

The name of the individual being referred.

Preferred Contact Information

Phone number, email, or another preferred method of communication.

Case Manager or Referral Source

Please identify the case manager or person making the referral.

Service(s) Being Requested

Tell us which service or type of support is being requested.

Preferred Service Location

Let us know where services would preferably be provided.

Brief Description of Support Needs

Provide a brief overview of the support needs being requested.

Preferred Start Date

Include the preferred start date, if known.

Best Way and Time to Contact You

Let us know the preferred contact method and convenient time to reach you.

WHAT HAPPENS NEXT?

A Simple Path to Getting Started.

After receiving your referral, a member of our team will contact you to discuss the individual’s needs, service availability, and next steps.

Submit a Referral

Provide the referral information through our referral form or contact our team directly.

We Review

Our team reviews the information and considers the individual’s needs and requested services.

We Connect

A member of our team contacts you to discuss service availability and the next steps.

Submit a Referral.

Please complete the form with the information you have available. A member of the Mukata Health Services team will follow up with you.

REFERRAL FORM

Tell Us About the Referral

Please provide the information requested below.

Please protect personal information.

Please do not include sensitive medical, financial, or other confidential personal information in this website form.

Individual’s Name *

Case Manager / Referral Source *

Preferred Email

Preferred Phone

Service(s) Being Requested *

Preferred Service Location

Preferred Start Date

Best Time to Contact You

Best Way to Contact You

Phone Email Either

Brief Description of Support Needs *

HERE FOR YOU

Supporting Greater Independence.

We look forward to supporting individuals in achieving greater independence, dignity, and quality of life.

Contact Our Team

We're Here to Help You Take the Next Step.

Have a question about referrals, services, careers, or getting started? Reach out to Mukata Health Services, LLC.

Call Us (913) 343-1627 Email Us mukatahealth@gmail.com