Join as a Provider

Florida’s Secure Placement Request — Powered by ITM Care Connect™

ITM Care Connect™ partners exclusively with licensed Florida Assisted Living, APD, Behavioral, Memory Care, and Rehabilitation facilities.

Complete the brief form below to begin your onboarding. Once approved, you’ll receive login access to our Provider Portal, where you can manage referrals, list open beds, and connect directly with pre-qualified families

Facility Information

Facility Name *

Business / Legal Name

Facility Type? *

Assisted Living (ALF)

APD Group Home

Behavioral Health / Rehab

Memory Care

Skilled Nursing

Other

select all that apply

What other Facility Type? *

License Number (AHCA or APD) *

License Expiration Date *

Number of Licensed Beds *

Facility Street Address *

Facility City / ZIP Code *

Facility County *

Primary Contact

Administrator / Director Name

Title / Role

Email *

Phone *

Preferred Contact Method *

Phone

Text

Admission & Population Served

Accepted Populations *

Seniors / Elderly

Developmental Disabilities (APD)

Behavioral / Mental Health

Memory / Alzheimer’s

Physical Disabilities

Veterans

Other

What Other Type of Accepted Populations *

Admission Criteria / Limitations *

Languages Spoken at Facility *

Emergency Admission Capability *

Yes, we accept same-day or 24-hour placements

No, standard admissions only

Financial & Placement Details

Payment Types Accepted *

Private Pay

Long-Term Care Insurance

Medicaid

Veterans Benefits (VA)

Other

What Other Payment Types Accepted *

Admission Fee (if any) *

Monthly Base Rate (starting at) *

Preferred Referral Radius (miles or regions) *

Do you offer respite or short-term stays?

Yes

Marketing & Listing Options

Would you like to feature your facility in our verified listings?

Yes – include photos and description

No – referrals only

Upload Facility Photos or Brochure

Facility Social Links / Website

Compliance & Agreement

I confirm that our facility holds a current Florida license and complies with all applicable AHCA and APD regulations. I understand that Florida Care Connect™ does not provide or bill for healthcare services. I agree that my participation is based on a marketing and referral arrangement, not a per-patient payment model. I further acknowledge that all data shared through the platform is handled using HIPAA-compliant systems.

Date *

Signature *

Clear