Mecca Care & Assistance logo
Mecca Care
& Assistance
Mecca Care logo

Referral Intake

Refer an Individual to Mecca Care & Assistance

A simple, secure form for Supports Coordinators, families, and guardians. All inquiries are responded to within 24–48 business hours (Monday–Friday).

1

Submit referral

Complete the secure form below — most referrals take under 10 minutes.

2

Intake & assessment

Our team contacts you within one business day to align on goals and start date.

3

Service delivery

Matched DSPs begin person-centered supports following the ISP.

Participant Information

Tell us about the individual being referred.

Service Details

Select the services being requested and proposed schedule.

Diagnosis & Support Needs

Help us match the right team and prepare for intake.

Include diagnoses, allergies, or medical conditions we should know about.

Supports Coordinator

Primary contact at the SC agency.

Family / Guardian Information

Optional — if different from the participant or SC.

Supporting Documents

Optional — upload the ISP, assessments, or other relevant files.

Additional Notes

Anything else we should know to support a smooth intake.

All information is kept confidential and used solely for service coordination.