Referral Form

For agencies, care workers, family members, and community members referring someone for support

Agencies

Social workers, case managers, healthcare providers, and community organizations

Loved Ones

Family members and friends who want to connect someone they care about with support

Self-Referral

You can also fill this out for yourself if you are looking for support and connection

About You — The Person Making This Referral
About the Person Being Referred
Needs & Services Requested
Additional Information

Your information is sent securely and goes directly to The Lazarus Project team.

Referral Received

Thank you for reaching out. The Lazarus Project team has received this referral and will follow up as soon as possible. If this is urgent, please also call us directly at 608-853-9010.

A confirmation has been sent to the email you provided.

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What Happens After You Submit?

  • Your referral goes directly to Kyle Wilke and The Lazarus Project team
  • We will review your referral and reach out within 1–2 business days
  • For urgent needs, please also call 608-853-9010
  • We'll connect the individual with appropriate resources — shelter, detox, recovery support, benefits, or community connection
  • All referrals are handled with dignity, confidentiality, and care