J & B Human Services — Referral Partner Inquiry
Share your organization details and referral interests—no client names or health information—then we’ll follow up within one business day.
Your name
*
First Name
Last Name
Title / role
Organization name
*
Organization type
Please Select
Hospital
Skilled nursing / rehab
Assisted living
Group home / residential program
Elder services / ASAP
Council on Aging / senior center
Elder law attorney
Placement agency
Church or community group
Other
Work phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work email
*
example@example.com
Towns you serve
What are you interested in?
Referring clients for homemaker / companion care
Overnight companion care
Personal care (starting soon)
Staffing support
Bilingual Kreyòl / French caregivers
Contract or vendor agreement
Brochures / business cards for our office
Other
Approximate referrals per month
Please Select
0–1
2–5
6–10
10+
Not sure
Best way to reach you
Phone
Email
Either
Message
Send to J & B
Should be Empty: