Referrals

To submit a request or referral for services, download the following form:
Download Referral Form (updated 04/07/2019)

Then upload it here:
Submit files securely

If you would like a copy of our HIPAA Statement for your records, you can get a copy here:
Download HIPAA Statement

This website was developed to be a resource to inform Minnesota residents about the Technology for HOME grant and its features. It was developed and is maintained by Technology for HOME staff, under contract with the MN Department of Human Services (DHS).

The MN Department of Human Services makes every effort to have its websites meet all state of Minnesota standards. To report a problem or concern with a webpage, contact Sue Redepenning at sue@livelifetherapysolutions.com.

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