Referral Form
Secure Referral Portal
Please complete the basic referral information below.
To protect privacy, please do not include detailed medical records, diagnoses, Social Security numbers, or sensitive clinical information in this initial referral.
Location / Service Area
Her Path to Peace LLC is located in Racine, Wisconsin and serves women seeking residential support in a women-centered Adult Family Home setting.
For privacy and safety, the full home address is not listed on the website. Please use the contact information below for referral-related questions.
Contact Information and Business Hours
Location: Racine, Wisconsin
Referrals: KharaMoore@zohomail.com
Contact Number: 608-509-2561
Business Hours: Monday–Friday, 9:00 AM – 5:00 PM
Saturday: By appointment only
Submission Instructions
Completed referrals should be sent directly to Khara Moore, MSW, APSW, SAC, CNA at KharaMoore@zohomail.com. A representative from Her Path to Peace LLC will review the referral information and follow up regarding next steps, availability, and appropriateness of placement.