RX Entry Form

ResourceXchange: Help Us Build Our Member-Sourced List

This is the form where our members may refer us to resources they stand behind and recommend to others in our community. BAiP's Neighbor-to-Neighbor Resource Exchange is only as strong as the referrals we receive so we appreciate your help to keep it fresh and filled with your top referrals. (Note: we do not vet these resources beyond your recommendation.)

We are looking for all sorts of referrals in the categories below.

Medical Care: doctors, dentists, massage therapists, physical therapists
Emotional and mental health care providers
Financial and legal service providers: lawyers, accountants, notaries
Home care workers
Home repair and maintenance service people: plumbers, electricians, handy people
Beauty: hairdressers, barbers, mani/pedicurists, tailors
Pet care: veterinarians, grooming, boarding, dog walkers, pet sitters
End of life arrangements, hospice, doulas, funeral/burial providers

To help us, enter your referral below. After you have entered your referral, click on the blue button at the end of the form. Then refresh your web browser and enter another referral. You may submit as many recommendations as you wish. (Note: This from is just for referrals; to request a resource, please click here.)

Enter your referrals here:

* Indicates required field

Type of provider/referral (please choose from the drop down list) *

Specify specialty or provide additional details *

Individual or Company Name *

Phone number and/or email (help us by providing as much contact information as you can) *

Comment (please indicate how often you have used this resource, level of satisfaction, etc. *

Your Name (in case we need to ask you questions) *

Your Email (if you don't use email, please enter your phone number) *

Please click the box below as your pledge that this is an independent referral and that you have used this resource or provider in the past. *

I have used this resource and am independently making this referral.

Click Here to Submit Your Recommendation

NOTE: To submit additional referrals, please refresh your web browser. If you have any issues with this form, please email: webmaster@bloominplace.org.