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Make a Referral

Thank you for helping connect someone with available services. Choose the referral form that best fits your situation. 

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I'm referring someone as part of my work. 

Healthcare providers, hospitals, social workers, government agencies, nonprofits, and other community partners. 

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Use the Professional Referral Form to provide service and clinical information that helps our Aging Services team review the referral efficiently. 

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I'm looking for help for myself or someone I know.

Individuals, family members, friends, neighbors, and caregivers. 

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Use the Community Referral Form to request services with everyday language to help our Aging Services Team understand the needs of the person referred. 

Not sure which form to use? We're happy to help. Call us at (252) 752-1717 or visit our Contact Page. 

Please complete the referral form and return it using one of these methods:​

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Mail to:

Council on Aging

Attn: Aging Services

4551 County Home Road

Greenville, NC 27858

or

Email to:

info@pittcoa.com

or 

Fax to:

252-752-9365

2026 Council on Aging

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