Care Coordination Liaison Interest Form

Thank you for your interest in LSI’s Care Coordination Liaison program.

This program provides support for families of children ages 0 to 5 who are experiencing a behavioral or mental health crisis. Our program focuses on supporting parents and children by connecting them with community resources that will meet their needs and help their family thrive.

Please complete the survey if you are interested in LSI's Care Coordination Liaison program and a staff member will reach out to you shortly after completing this survey.

Name

Phone Number

Child Date of Birth or Due Date

Do you prefer a text message, video call, or phone call?

Text message

Video call

Phone call

What county do you live in?

Cedar

Clinton

Jackson

Muscatine

Scott

Other

If Other, please list here.

Any questions about the program?

Feel free to ask a question or simply leave a comment.

Comments / Questions