Service Referral Form
Complete the Service Referral Form
Whether you are a case manager, family member, or looking for support for yourself, we look forward to working collaboratively with you.
If you are seeking services simply complete our referral form and one of our friendly team members will be in touch within 1-3 business days. Aptiv will assess all referrals that are submitted and we have a three-step process that helps Aptiv determine the ability to serve.
Step 1
Aptiv's Community Outreach Specialist or the Services Manager for the primary service of interest may reach out if there are additional questions and details needed.
Step 2
The Services Manager for your primary service of interest will attempt to reach out to you within 2-3 business days to schedule an assessment.
Step 3
An Aptiv team member will connect with you to provide a determination on the ability to serve you and the next steps within 5 business days from the completion of the assessment.
