Complementary Support Services is dedicated to assisting individuals and their families with special circumstances to remain in their community, live independently and enjoy life.
Referrals
Have Questions? Contact Us

If you want to call CSS click here:
https://me.vonage.com/cssrocks

email info@css-web.org

Welcome to the CSS Referral page. You may submit a referral for our consideration to CSS through this page. In order for this submission process to succeed, you must complete every part of the form.

Information About You
Your Name: A value is required.
Your Email: A value is required.Invalid format.
Your Telephone Number: A value is required.
Best Method to Reach You: A value is required.
My Relationship to the Client: A value is required.
Information About The Client
Name: A value is required.
Date of Birth: A value is required.
Address: A value is required.
City: A value is required.
State: A value is required.
Zip: A value is required.
Telephone Number:
Special Circumstances
Clients Current Condition(s): A value is required.
History of Condition(s): A value is required.
What assistance is needed in activities of daily living? A value is required.
Other Issues and Concerns:

 

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