Call: (415) 355-6700 or email us at: ihssci-2026

1. Click ‘Get Form’ to open the In-Home Supportive Services Referral Form in the editor.
2. Begin by filling out the IHSS Applicant section. Enter your last name, first name, middle initial, street address, zip code, social security number, birth date, phone number, and email. Ensure all information is printed clearly.
3. Indicate your gender identity and sex at birth by selecting the appropriate options provided. You can also specify your sexual orientation and ethnicity.
4. Complete the Referent Information section if applicable. Provide details about the referent's relationship to you and their contact information.
5. Fill out the Residence/Discharge Information section regarding your living situation and any relevant medical history. Be sure to answer questions about household members and emergency care needs.
6. In the Medical and/or Mental Health Information section, provide details about your diagnosis or medical conditions as well as any additional comments that may assist in assessing your needs.
7. Finally, review all sections for completeness before submitting. If you have questions during this process, feel free to reach out via phone or email for assistance.

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