Pre-Discovery Intake

Please complete this brief intake so we can better understand your agency’s needs before scheduling your complimentary Discovery Consultation.

After submitting the form below, you’ll be directed to select an available time for your 15–20 minute Discovery Consultation.

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Agency Name *

Contact Name *

First

Last

of you to

Contact Title / Role *

Email *

Phone Number *

Services Provided *

Community Residential Alternative (CRA)
Community Living Support (CLS)
Community Access Group (CAG)
Community Access Individual (CAI)
Supported Employment
Nursing Services
Behavioral Supports
Respite
Other

Other Service(s) Provided

If you selected “Other” above, please list the additional service(s) your agency provides.

Current Census / Number of Individuals Served *

No PHI, no names—just the number.

Approximate Staff Count *

Number of Service Locations / Sites *

What prompted you to contact Solentra CORE? *

Preparing for an upcoming regulatory or quality review
Compliance, documentation, or clinical-system concerns
Corrective Action Plan (CAP) support
Workforce training or competency needs
HRST-related support
Strengthening internal systems or processes
Other / Not sure

Upcoming Review, Survey, or Deadline

If applicable, please identify the type of review, survey, corrective-action deadline, or other time-sensitive event and the anticipated date.

Please briefly describe what you need help with.

You may also use this space to explain an “Other / Not sure” selection above. Please do not include individual names, medical information, or other protected health information (PHI).

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