Illinois Pathways to Health Referral - General Referral
General Referral

9/23/2026- 12/31/2028 at 1048 Lake St, Oak Park, IL 60301-1546 - County: Cook

Provided by AgeOptions through the Illinois Pathways to Health project.

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Make a referral

Do you know someone who could benefit from one of IL Pathways to Health’s health promotion workshops? Whether you are a friend, a relative, or a health professional, it’s easy to make a referral. When you refer someone to one of IL Pathways to Health's workshops, they will be contacted by a representative in their area within three business days. The representative will help them find a workshop that best fits their needs.

Please fill out the form completely. For more information about IL Pathways to Health workshops, please call us toll free at (800) 699-9043.

Reason for referral

Enrollment

Referral creation source Calculated

Unanswered

For AgeOptions staff:

If enrolling in a program: Use the links below to create a person record and course registration pre-filled with the collected referral data. This referral will be automatically linked to the program. When finished, set the referral status to Completed and select Eligible: Enrollment created as the closure reason.

Enroll in Take Charge of Your Health

Details

Participant first name: Unanswered
Participant last name: Unanswered
Participant phone number: Unanswered
Participant email: Unanswered

Enroll in Take Charge of Your Diabetes

Details

Participant first name: Unanswered
Participant last name: Unanswered
Participant phone number: Unanswered
Participant email: Unanswered

For AgeOptions staff:

If enrolling in PROGRAM: Change the status to Completed and select Eligible: Enrollment created as the closure reason. You will then be prompted to create the enrollment for this person.

If not enrolling: Set the referral status to Completed and select the appropriate closure reason.

Closure details

Referral closure reason

Select only one

Eligible: Enrollment created Eligible: Enrollment not created Ineligible Invalid referral submission Not enough information, submitted in error, etc.

Information of person being referred

First name

Last name

Email not required if phone provided.

Phone number

Do you have permission from the individual being referred, or their authorized representative, to submit this referral for the purposes of sharing of relevant information for program eligibility and service coordination?

Select only one

Yes No Self-referral

Information of person offering the referral

Name/Provider

Email address