Start the Referral
Share the requested service, county, your role, and where the person is in the referral or authorization process.
For care coordinators, guardians, healthcare and rehabilitation professionals, and other partners helping an adult explore ESP services.
← Back to Every Step PathwaysStart with general referral information. If we need protected information or documents, we’ll give you a secure way to send them.
Do not submit Social Security numbers, Medicaid/member IDs, detailed medical records, diagnoses, care plans, authorizations, or other protected health information through this public form.
We start by reviewing the service, location, authorization status, network requirements, and current capacity to see whether ESP may be a fit.
Share the requested service, county, your role, and where the person is in the referral or authorization process.
ESP reviews the request, current availability, and whether the referral appears to fit the services we are preparing to provide.
If it looks like a fit, we’ll explain the next intake steps and provide a secure method when protected information is needed.
This form starts the conversation. An ESP team member will follow up about provider fit and next steps.
Website inquiry response standard: within 2 business days.
If you’re unsure whether the referral is ready, contact us before sending sensitive information. We can help clarify the next step.