HSS ReferralClient InformationClient Name *Date of Birth *Phone Number *Address *Requested Service *Number of Hours Per WeekLanguage SpokenCase Manager InformationCase Manager's Name *Case Manager Phone Number *Case Manager's Email Address *MessagePlease submit a CSSP and a MN Choice Assessment. (PDF, DOC and DOCX file only) *PDF, DOC and DOCX files onlyIf you don't receive a confirmation email, your referral didn't go through. Please refresh the page and try again.
