OHH Referral & Partner Collaboration Form

OHH Referral & Partner Collaboration Form

Share your interest in referrals, partnerships, and collaboration opportunities with Our Helping Hands (OHH).
ABOUT OHH HEALTH SOLUTIONS
Our Helping Hands (OHH) Health Solutions provides patient advocacy and healthcare navigation services that help seniors, caregivers, and families manage healthcare challenges.

Common services include:
• Patient advocacy and care navigation
• Medical bill and insurance issue assistance
• Appointment coordination and care planning
• Support for families managing complex healthcare situations

OHH frequently collaborates with:

• Home health agencies
• Home care agencies
• Skilled nursing facilities
• Adult day programs
• Senior living communities
• Healthcare professionals
ELECTRONIC CAREGIVER REFERRAL PROGRAM
Electronic Caregiver (ECG) provides remote monitoring technology such as Addison Care (Virtual Caregiver) to help seniors live safely and independently. Referral partners may receive a $50 Visa eGift card after a referred client completes their first product payment.

Partners who want deeper involvement may later explore becoming a Master Care Partner (Reseller).
OHH REFERRAL REWARDS
Referral partners who refer clients to OHH services may receive the following eGift card rewards if the client enrolls:

• $250 – Patient Advocacy Premium Service
• $150 – Standard Package (Ongoing Care Navigation)
• $75 – Essential Package (Peace of Mind Support)
• $50 – Other OHH services
• $25 – Quick Bill Review service

Referral rewards are issued via email as an eGift card after service enrollment is confirmed.
For a full list of services visit www.ourhelpinghandscare.com
REFERRAL PARTNER CONTACT INFORMATION
Full Name*

First NameLast Name
Business Name*
Title or Role*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Website (optional)
City & State*
BUSINESS INFORMATION
Home Care AgencyHome Health AgencySkilled Nursing FacilityAdult Day ProgramSenior Living CommunityHealthcare ProfessionalInsurance ProfessionalOther
Briefly describe your business and the clients you typically serve.*
HOW YOU HANDLE REFERRALS
EmailPhoneOnline formOther
YesNo
If yes, please briefly describe your referral structure and rules.
Upload any of the following: Referral agreements/Partnership paperwork/Referral guidelines or policies

Cancelof
SECTION 7 – REFERRAL INTEREST
I would like to refer clients for OHH patient advocacy servicesI would like to refer clients for Electronic Caregiver productsI am interested in both opportunitiesI would like more information first
SECTION 8 – ADDITIONAL REFERRAL PARTNERS
List any other businesses you believe may be a good referral partner for OHH:
SECTION 9 – PATIENT ADVOCATE INTEREST
I would like to learn more about how to become a Patient Advocate.
SECTION 10 – FOLLOW-UP REQUEST
Yes – schedule a callMaybe laterNo follow-up needed
Preferred day for follow-up call*
MorningAfternoonEvening
SECTION 11 – AGREEMENT & SIGNATURE
By submitting this form, I acknowledge that I am providing referral information voluntarily and agree to represent Our Helping Hands (OHH) Health Solutions and Electronic Caregiver professionally.

I understand that referral rewards are only issued after confirmation that a referred client has enrolled in a service or product.

I also agree not to discuss or disclose OHH or ECG pricing with clients, as pricing and service recommendations must be communicated directly by OHH or ECG representatives.
I agree to the above terms and conditions.
Electronic Signature*

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OHH Referral & Partner Collaboration Form

ABOUT OHH HEALTH SOLUTIONS

ELECTRONIC CAREGIVER REFERRAL PROGRAM

OHH REFERRAL REWARDS

REFERRAL PARTNER CONTACT INFORMATION

BUSINESS INFORMATION

HOW YOU HANDLE REFERRALS

SECTION 7 – REFERRAL INTEREST

SECTION 8 – ADDITIONAL REFERRAL PARTNERS

SECTION 9 – PATIENT ADVOCATE INTEREST

SECTION 10 – FOLLOW-UP REQUEST

SECTION 11 – AGREEMENT & SIGNATURE