Family intake

Tell us what kind of private support you need.

This form is a front-end intake screen. Before going live, connect it to a secure form service or database and add the correct Hope Educational Services contact email. Families may search for free during launch, and the first request may be submitted for free.

Parent, Guardian, or Adult Client Full name Email Phone City and state ZIP code Preferred search radius

Who Needs Support? Support is for Age or age range Preferred service setting Helpful context

Service Categories Other or unknown need

Safety Preferences

I want providers with completed background checks. I want license or certification verification when applicable. I want references available before booking. I want Hope to help me understand what reference questions to ask. I understand Hope Care Connect is not for emergencies.