Get Help

Through your practice’s partnership with Unite Us, you can proactively request support for yourself or your family using this simple online Assistance Request Form. Whether you need a ride to the pharmacy or help with meals, we are here to ensure you get the support you need.

Please Note: Filling out this form means you’re asking to be connected to a service provider in your area who’s able to meet a need that you or someone in your care may have. Once completed, this form is sent to a Care Coordinator, and someone will contact you within two (2) business days. The information you enter is completely confidential, and there is no cost for this service.

Please use this form only to request services for yourself or a child (under 18 years old) or an adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services or by their parent or legal guardian only.

This form should not be used for emergency or crisis needs. Requests will only be reviewed during normal business hours. Do not send requests for individuals requiring immediate support for mental health and/or substance use needs.