Fill out this form to request a free phone call appointment with an Options Counselor in the Aging & Disability Resource Center.

Options counseling is a free service that helps older adults, people with disabilities, and family caregivers think through the various options for long-term services and supports. Options counseling may include a review of long-term services and supports (in-home care, assisted living, nursing facility placement, etc.), assessments for home- and community-based services (Medicaid waivers, CHOICE, home-delivered meals, etc.), or community resource referrals (housing, legal, food pantries, etc.). Referrals will be responded to in the order received.

LifeSpan Resources serves the following counties in Southern Indiana: Clark, Floyd, Harrison, Scott. If the individual needing assistance lives outside of this area, please visit in.gov/fssa/inconnectalliance to locate the appropriate Aging & Disability Resource Center.

If you are seeking information on behalf of someone else, please notify the individual that you are making this referral and that LifeSpan Resources will contact them by phone. Individuals have the right to refuse any and all services, including LifeSpan Resource’s initial phone assessment. In the event that LifeSpan Resources has attempted to make contact with the individual without success, it will be the responsibility of that person to contact LifeSpan Resources directly through the Aging & Disability Resource Center at 812-948-8330.

LifeSpan Resources can only accept this referral form, not healthcare providers’ own forms, in order to obtain the information needed to assist our community members.