REAL Services

Guest Speaker

Vern Yip

In the News:

BBB Alerts Consumers about U.S. Census Workers: Be Cooperative, But Cautious!

Referrals

Complete the form below if you or someone you know would like to be options counseled regarding comunity resources and eligibility for our In-Home Servcies Program. After we receive the form, we will contact the person listed in the Assessment Contact name. If you would like to call to make a referral, please call 574-233-8205 or 800-552-7928 (within Indiana Only).

County
Name
Street Address
City/State/Zip
Phone
Social Security #
DOB
Age
Marital Status
Spouse's First Name
Medicare	Yes
Supplimental Health Insurance:	Yes
Medicaid #
Spenddown Amount
How Spenddown is met
Possible waiver	Yes
Monthly Income
Comments/Health Problems/Disabilities
Assessment Contact Name
Contact Address
Contact Phone Number
Initiated By
Address
Email

REAL Services 1151 S. Michigan Street South Bend, IN 46601 Fax: 574-284-2691 Office Locations List of Holidays our Offices are closed	The Promise of Community Action Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community, and we are dedicated to helping people help themselves and each other. REAL Services, believing in the dignity of all people, will provide services to eligible persons without regard to race, creed, sex, or national origin.
Web site last updated on September 23, 2009	To Report elder abuse: Adult Protective Services