Refer a Client - Harmony Home Services

Your Dedicated Referral Coordinator

Khalid Mohamed

Referral Coordinator

Your single point of contact for all referrals. Khalid ensures no referral falls through the cracks and provides timely updates on client status.

(651) 279-4382 referrals@harmonyhomeservices.org

Available: Mon-Fri 8AM-5PM CST

Choose Your Preferred Referral Method

Online Form

Complete referral form directly on our website. Instant submission and immediate confirmation.

Download PDF

Download our referral form, fill it out, and email or fax it back to us.

Download PDF Form

Phone Referral

Call our referral coordinator directly to make a referral over the phone.

Call Now

Client Referral Form

Thank you! Your referral has been submitted successfully. Our coordinator will contact you within 24 hours.

Referrer Information

Your Name *

Organization *

Phone Number *

Email Address *

Client Information

Client Name *

Client Phone

Client Email

Current Address

Eligibility Information

Medicaid ID (if known)

Date of Birth

Current Housing Status *

Disability Status

Service Needs

Services Needed (check all that apply)

Housing Search & Application Assistance

Landlord Negotiation & Advocacy

Benefits Application Assistance

Housing Stabilization Support

Case Management

Urgent Needs or Immediate Concerns

Additional Information

Release of Information

* I have obtained verbal or written consent from the client to share this information with Harmony Home Services for the purpose of providing Housing Stabilization Services.

* I give permission for Harmony Home Services to contact me regarding this referral and provide updates on the client's status.