Downloadable Forms

Referral Form

This downloadable Referral Form is for case managers to use. If you are on a waiver or would like assistance, please contact your case manager and request they submit your referral to Worry Free Mobility.

Contractor Identifier Form

If you are a contractor looking to do work with Worry Free Mobility, please download this form. If you are a homeowner with an existing contractor who you want to work with Worry Free Mobility, please refer them to this form as well.


Worry Free Mobility is invested in guiding our clients through their home accessibility remodels and needs using the county waver program. We can offer simple assessments or guide your project from initial consultation all the way through completed construction. We want to keep things as simple as possible for you through this entire process. Your home reconstruction can be covered under the Environmental Accessibility Adaptations (EAA) waiver service if you have one of the following waivers:

  • Developmental Disabilities Waiver (DD)
  • Elderly Waiver (EW)
  • Brain Injury Waiver (BI)
  • Alternative Care (AC) Program
  • Community Alternative Care Waiver (CAC)
  • Community Access for Disability Inclusion Waiver (CADI)

You can find out more by visiting the Minnesota Department of Human Services informative webpage by clicking the button below.