Provider/Professional Referral

PCOA is not an emergency service. If you are experiencing or witnessing an immediate threat to life, health, or safety, call 911 immediately. In the case of abuse or neglect, please contact Adult Protective Services at 1-877-767-2385. Learn more about reporting abuse, neglect, or exploitation here.

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.

Client Information

Referral Source

Services or Referrals Requested

Please be aware that some of the services below have a significant waitlist and will be prioritized based on client need.
After your referral is received, a team member will reach out in 1-3 business days to make contact with you or the person you are referring (based on your indication above) to assess the situation. If you are concerned that the individual you are referring won't be accurately assessed by phone, please let us know so that we can arrange a time for you to be in person with them to assist them with the phone conversation.