Make a Referral

Simple. Secure. Person-Centered.

At Koastal Home Health Care LLC, we make the referral process easy and responsive. We work closely with case managers, social workers, healthcare providers, and families to ensure every referral is handled with care, accuracy, and urgency.

 

Use the form below to submit a referral for Minnesota 245D Waiver Services, including IHS, ICLS, Chore Services, Employment Services, and more.

Referral Form

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Referring Party Information

Client Information

Address

Program & Service Information

Waiver Type (check all that apply)
Requested Services (check all that apply)

Case Manager Information

Medical & Support Information

Any safety concerns?
Does the client have a legal representative?

Additional Information

Click or drag a file to this area to upload.

How to Submit

You can submit this referral by:

📧 Email: info@koastalhomecare.com
📠 Fax: 763-402-7003
📞 Phone: 763-257-6780

(We respond to all referrals within 24–48 hours.)