Adult Guardianship Intake Form

You may submit a referral to the Adult Guardianship Division using this form or by calling 312-603-0800 between 8:30a.m. and 5:00p.m., Monday through Friday, and asking for the Intake Department.

Upon receipt of your referral, the Intake Department will contact you for additional information. The Intake Department investigates to determine if a guardian is appropriate and if the Public Guardian is appropriate to serve as guardian. If you suspect that someone is at immediate risk of abuse, neglect, or exploitation please call 911 or Adult Protective Services at 1-866-800-1409.

Person You Are Referring

Name(Required)

First Last

Age

Phone

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Address (if different than above)

Street Address Address Line 2 City State ZIP Code

Phone

Referring Party (your information)

Name(Required)

First Last

Relationship to Person You Are Referring

Phone(Required)

Address

Street Address Address Line 2 City State ZIP Code

Reason for Referral(Required)

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