IHSS Referral form 2026

1. Click ‘Get Form’ to open the IHSS Referral form in the editor.
2. Begin by filling out the 'IHSS Applicant' section. Enter the applicant's last name, first name, middle initial, and contact information including street address, zip code, phone number, and email.
3. Indicate the applicant's gender identity and sex at birth by selecting the appropriate options provided in the form.
4. Complete the 'Referent Information' section if applicable. Provide details about the referent's relationship to the applicant and their contact information.
5. In the 'Residence/Discharge Information' section, specify living situation details and whether the client lives alone. Include any relevant discharge information if applicable.
6. Fill out medical and mental health information, including diagnosis and any additional concerns that may affect service needs.
7. Finally, review all sections for completeness before submitting your form to ensure a smooth processing experience.

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