Serving Philadelphia, Bucks, Montgomery, Chester & Delaware Counties
(800) 507-2157
Referral Portal
Referral & Intake Portal
For participants, families, case managers, supports coordinators, hospitals, and healthcare partners — submit a referral or apply for services with Galeron.
Apply for Services
For participants and families seeking OLTL or ODP waiver services. Complete the intake form below or contact us directly to get started.
- Participants seeking OLTL services
- Participants seeking ODP services
- Family members requesting services
- Self-referrals for any waiver service
Refer a Participant
For case managers, supports coordinators, hospitals, social workers, and healthcare partners referring a participant for Galeron services.
- Supports Coordinators
- Hospital discharge planners
- Social workers & case managers
- MCO care managers
- Healthcare partners
Service Request / Referral Form
Complete the form below and a Galeron team member will contact you within 1 business day.