Referrals

Submit Your Referral

Are you or your client seeking assistance with housing support services? If yes, please take a moment to complete the form below, providing any pertinent details. Our dedicated referral team will reach out to you within 24 to 48 hours.

For any questions about this process, feel free to reach us at:

(612) 688-1193 or info@integrusmn.com

Referral Inquiry Form

Referral Type *

Client Section

If you are submitting your own referral as a future client or on behalf of a future client, please complete this section:

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Client: Full Legal Name (First, Last) *

Client: Date of Birth (MM/DD/YYYY) *

I am currently on an active waiver-program:

CADI Waiver
EW - Elderly Waiver
DD - Developmental Disabilities Waiver
None

Do you a care coordinator, case manager, social work or therapist you regularly work with? *

Please describe your current housing status or primary housing concern: *

Client: Contact Number *

I am 18 years or older AND currently active on medical assistance *

Client: Email Address

If YES, please provide their full name and contact information (phone number or email):

Client: If moving, preferred city or county of relocation:

Case Manager Section (If Applicable)

If you have an assigned case manager, case worker, care coordinator or social worker, please complete this required section.

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Case Manager: Full Name

Case Manager: Email Address

Confirm Email

Case Manager: Contact Number

[Optional] File Upload

/ For Waivers Clients: Please upload an updated and complete CSSP or CCP listing Integrus LLC as the housing stabilization services provider. Include active start and end dates. / Non-Waiver Clients: Please upload a current Professional Statement of Need (PSN) and Housing Focused Person-Centered Plan (HFPCP). If your client does NOT have a HFPCP and needs a housing consultation, you do only need to upload the PSN. / Integrus NPI: 1063295582 /

Referrals

Submit Your Referral

Referral Inquiry Form

Client Section

Case Manager Section (If Applicable)

5200 Willson Road
Edina, MN 55424

Ⓒ 2024 - Integrus LLC. ALL RIGHTS ARE RESERVED

HIPAA & PRIVACY POLICY

Referrals

Submit Your Referral

Referral Inquiry Form

Client Section

Case Manager Section (If Applicable)

5200 Willson Road Edina, MN 55424

Ⓒ 2024 - Integrus LLC. ALL RIGHTS ARE RESERVED

HIPAA & PRIVACY POLICY

5200 Willson Road
Edina, MN 55424