Program Information Form
Please use separate forms for each program or service that you provide.
HeartLine information and referral is a free service to the public. Referrals are made based on the client’s service needs and location. A listing in the HeartLine database does not constitute an endorsement by HeartLine. HeartLine reserves the right to edit information for brevity, clarity and content; and to publish the information in a variety of media, subject to confidentiality issues.
If you are running out of funds, temporarily discontinuing your service, or have any other corrections to the information in our database, please contact the resource database department immediately. Inclusion in the HeartLine database indicates your willingness to provide us with updated agency/program information by request and as needed. Referrals made with accurate and complete information will help our callers, as well as your agency in the reduction of unnecessary inquiries.