Let's Start the Conversation

Taking the first step toward care is important — and we're here to make it easy. Fill out the form below and our referrals team will reach out to guide you through next steps.

Service Inquiry Form

This form is an initial inquiry only. Submitting it does not determine eligibility or enroll anyone in services. A member of our referrals team will follow up to discuss next steps.

You may also reach our referrals team directly by email:

referrals@alwayslgh.com

Privacy note

This form collects contact information alongside a request for health-related services. We use it only to follow up on your inquiry. Please do not include Social Security numbers, Medicaid numbers, dates of birth, diagnoses, or other sensitive documents in this form.

Name of person seeking services *

Your name (if different)

Relationship to person

Age range *

County *

City *

Phone number

Email address

Please provide at least one way to reach you.

Preferred contact method

Services you are interested in (select all that apply)

Best time to contact

How did you hear about us?

Name of person who referred you (if applicable)