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Adult Services Referral
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We care about Wilson County's Older & Disabled Adults. Is there an older or disabled adult who needs services in order to remain home safely? If so, please fill out this form and click submit. A social worker will respond to you within 48 hours.
PLEASE DO NOT MAKE ADULT PROTECTIVE SERVICES REFERRALS ON THIS FORM. CALL 206.4000 OR 911 AFTER 5:00 PM. Thank you!
Older/Disabled Adult Information
Name of Older/Disabled Adult:
Daytime Phone Number:
Date of Birth
Last four digits of individual's Social Security Number
Contact name and phone number
Does individual have?
In order for our department to make an assessment of needs, please list a brief description:
Thank you for completing this Adult Service Referral.
PLEASE DO NOT MAKE ADULT PROTECTIVE SERVICES REFERRALS ON THIS FORM. CALL 206.4000 OR 911 AFTER 5:00 PM.
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