HEART BHAM Service Request

This form is only for use for non-urgent requests for homeless outreach in areas serviced by the HEART BHAM program.

Incidents that are violent, criminal, or medically urgent are not eligible for a HEART BHAM response.

Please verify that the location is within the service area by checking the HEART BHAM map.

Please provide a detailed description of the person(s) and/or encampment; any specific location at the address (alley, rear, front, north side of the property, etc.); indicate any specific services that the person experiencing homelessness may need.

HEART BHAM operates from 7:30am-11:00pm CT daily

Your email address

Your Name:

Organization or Affiliation

Citizen Reporting Name

Citizen Reporting Phone Number

What is the specific location of the individual(s)?

Please provide a description of the individual(s) and any particular issues/needs and any relevant history:(optional)

Are other outreach organizations currently working with the individual(s)? If so, please provide the organization and a POC.(optional)

Please provide additional details regarding your request:

What is the desired outcome?

Attachments(optional)

Add file or drop files here