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EIHAB Human Services
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Pennsylvania Service Locations
INDIVIDUAL COMMUNITY
Lehigh, Pennsylvania Tunkhannock, Pennsylvania
RESIDENTIAL SUPPORTS
Lehigh, Pennsylvania Tunkhannock, Pennsylvania
Submit Referral Form
Your First Name
Your Last Name
Your Email
Your Phone
What is your relation to Person Applying:
Self
Care Manager
Parent
Family
Other (indicate in comment)
Which Services Are You Interested in?
Residential
Community Habilitation
Residing County
Does the person have CCP or SP?
Yes
No
Not Sure
Does the person have ODP eligibility?
Yes
No
How Did You Hear About Us?
Choose an option
Person's First Name
Person's Last Name
Age
Does the person have a Support Coordinator
Yes
No
Support Coordinator Email
In Summary, What are Person's Life Goals
Additional Comments
Get Started
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