Complete the form below if you or someone you know would like to be provided Options Counseling regarding community resources and/or eligibility for our In-Home Services Program.

After we receive your submission, we will review the request and contact the person listed in the Assessment Contact Name field. If you would like to call to make a request, please call 574-284-2644 or 800-552-2916 (within Indiana Only).

Please keep the following in mind as you complete this request form:

• REAL Services Inc., serves the following counties in Indiana, for Options Counseling and Information/Resources: Elkhart, Kosciusko, LaPorte, Marshall, and St. Joseph
• Please fill out the Online Request Form completely
• Individuals have the right to refuse any and all services
• Prior to submitting this request, please inform the individual in need of assistance, and/or their family, that you are making a request to REAL Services Inc. on their behalf
• If your name is listed on the referral, we may be contacting you for more information
• We make all attempts to reach the contact individual within 48 hours of submission
• We make two separate attempts, to the individual listed on the referral, before closing out the referral request