The Colbert Consent Decree Program was established to provide persons living in Cook County nursing homes an opportunity to live more independently
in the community setting of their choice. If you are interested in learning more about the Colbert Consent Decree Program for yourself or for another individual,
please fill out this form and someone from one of the participating Colbert Providers will contact you.
If you have any questions in filling out this form, please contact the Senior HelpLine 1-800-252-8966 or email the Colbert Consent Decree
Information about the person being referred
How did you hear about the Colbert Consent Decree?
Information about the person making the referral
You are making a referral for someone else. By completing this form, you agree to be contacted by a representative of one of the Colbert Providers.