Housing Referral · Custom Portal

Thank you for making a referral to National Health Foundation.

Fill out the form below or if you prefer to make a referral over the phone you can call 888-NHF BEDS (888-643-2337) - 24 hours a day, 7 days a week. To send us more patient information you can fax us at 877-551-5580.

Referring Organization Information

Referring Organization Source Type

HN Referral Source

HN Referral Source Contact

Referral Source Phone

Location

Criteria

Is this participant experiencing homeless under HUD definitions?

Is this Participant Aware of the referral

What is the Current Living Location of Participant?

First Name

Middle Name

Last Name

DOB(MM/DD/YYYY)

Gender

Primary Language

Other Primary Language

CIN

Notes (Optional)

You can upload H&P notes, Face Sheet and Covid-19 test here or you can send them through fax at 877-551-5580.
Choose one or more files to upload, files must all be added at the same time or previous selections will be overridden.

Generate a new image Play the audio code

Enter the code from the image

To upload multiple files:

Make sure all of the files are in the same folder
Select "Choose Files"
Hold the "CTRL" key and click each file or Click and drag the mouse to select
Click "Open"

If multiple files are selected, the number of files will appear next to the "Choose Files" button.