Referral Form

Refer a client in a few minutes.

Share the basics and our intake team will follow up to confirm eligibility, funding and a start date. Prefer to talk first? Call us any time.

How to make a referral

  1. Call us at 952-204-3912
  2. Submit this form online or email it to our intake team
  3. Visit our office at 9016 Morgan Ave S, Bloomington, MN 55431

What happens next

  1. Intake call — we review needs, schedule and funding.
  2. Person-centered plan — built with the client, family and case manager.
  3. Staff match & start — caregivers introduced before services begin.

Rather talk it through?

Our intake team is available Monday–Friday.

  1. Phone: 952-204-3912
  2. Address: 9016 Morgan Ave S, Bloomington, MN 55431
  3. Fax: 612-587-1080
  4. Info@bloomlivingmn.com
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Client & referrer details

Guardian / primary contact (if applicable)

Case manager information (if applicable)