Conservator Referral Form

Guardian is open to the public by appointment only.
Please reach us during business hours, or for after-hours emergencies at:
Main Office 269.963.3253 | Toll-free (866) 963-3253 | Fax (269) 966-2485

BATTLE CREEK OFFICE
693 Capital Ave., SW, Unit #3, Battle Creek, MI 49015

KALAMAZOO OFFICE
2323 Gull Rd, Suite A, Kalamazoo, MI 49048
CONSERVATOR

REFERRAL FORM
DIRECTIONS:
1. In order to ensure a faster processing time, please complete this form completely.
2. The client intake/discharge specialist will contact you with any additional questions. A decision will not be made on the referral without all requested information.
3. As the petitioner, you will be contacted with the referral outcome. It is your responsibility to inform the appropriate parties of this decision. It is also your responsibility to ensure that Guardian Finance and Advocacy Services is provided with the date/time of the court hearing.
4. Please be aware that Guardian Finance and Advocacy Services reserves the right to decline a referral based upon the individuals situation and/or the capacity of Guardian Finance and Advocacy Services at the time of your request.

Person Making the Referral
Person Referring*

First NameLast Name
Date

MonthDayYear
Relationship/ Agency
Phone Number*

Area CodePhone Number
E-mail*
How did you hear about us?
Services Requested (Please check all that apply):

Special ConservatorFull Conservator
Reason for Referral

0/50

Family and Interested Party Information
List all family members giving their relationship, name, address, and telephone numbers
Are any family members or interested parties attempting to become guardian for the Individual? If yes, please describe why a third party is being contacted.
THIS REFERRAL IS VALID FOR 6 MONTHS, AFTER

THAT PERIOD, A NEW APPLICATION IS REQUIRED
Should be Empty:

CONSERVATOR