Apply for services
Starting Supported Community Living with Nezia Care begins with one form. Here's how it works.
Thank you for thinking of us
Choosing who supports someone you love is a big decision, and we don't take it lightly. At Nezia Care we give the kind of support we'd want for our own families: patient, respectful and built around the person's own goals.
Whether you're a case manager, a family member, a guardian or the person seeking services, the intake form below is the place to start. It tells us enough to see how we can help and to plan a good fit.
We serve the Des Moines metro, including communities in Polk, Dallas and Warren counties. See what our SCL services include.
Three steps to apply
Download the form
Use the button below to get the intake form as a PDF. It's two pages.
Fill it in
Complete it with the person and their team. Leave blank anything you don't know yet.
Send it to us
Call 515-421-6509 and we'll arrange a private way to send it, or email it to patrick@neziacare.com.
Intake and referral form
PDF, 2 pages, about 70 KB
Rather talk it through first?
Send your contact details and we'll call you, or call us at 515-421-6509.