Help Your Seniors Remain Independent with a Direct Referral to Lifeline

Did you know that when you just recommend our services, only 5% of those seniors will actually contact Lifeline on their own due to confusion around the referral process? However, when you make a direct referral on behalf of your the seniors in your care, over 65% will most likely follow the advice of their physician or nurse.¹

The referral process is as easy as 1-2-3

Explain how Lifeline is more than just dialing 911
Obtain consent
Refer your at-risk senior to Lifeline via the form below

Refer Your Senior to Lifeline

If you would like to refer a senior – please provide the requested information. Upon receipt, one of our qualified intake specialists will contact your at-risk senior to review the available options and help select the solution that’s right for their needs.

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Your Name*

First Last

Your Phone

Your Email

Referral Code

Organization

Senior's Name*

Senior Date of Birth*

Contact's Name*

Contact's Phone*

Hidden

Senior's Phone*

Become a Referral Partner

If you would like to join the Lifeline family and become a referral partner – please provide the requested information. We will send you a complimentary ‘Welcome Kit’ that includes information about our solutions and money-saving coupons you can share with your at-risk seniors.

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"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Organization

Job Title

Referrals can help keep your seniors safe and healthy!

¹Alvarez C., Saint-Pierre C., Herskovic V., Sepúlveda M., “Analysis of the Relationship between the Referral and Evolution of Patients with Type 2 Diabetes Mellitus.” Int J Environ Res Public Health. 2018;15(7):1534. Published 2018 Jul 20. doi:10.3390/ijerph15071534