If you got here by accident from the Texas Ramp site…

Go back! (We build ramps only in New Mexico.)

If you are someone who needs a ramp…

Because we not in a position to evaluate the medical or financial needs of prospective clients, we cannot take referrals directly from clients. Please contact your healthcare professional or caseworker about coming here to make the referral.

If you are a healthcare professional or caseworker…

… and you have a client who needs a ramp, you are in the right place – just complete the referral form below. All fields indicated with an asterisk must be completed. (Missing information only delays the process.) Do not include any protected medical information.

Also, please note that our ability to provide ramps is restricted by our current state of funding and backlog of pending referrals. We are a donation-funded, all-volunteer group. Consequently, we cannot make any commitment regarding the time frame for building a specific ramp. We will do our very best for every client.

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Client Name *
First name
Please enter the client's first name

Last name
Please enter the client's last name
Client Address *
Address line 1
Please enter the client's address
Address line 2
Client City *
Please enter a valid city
or "Not Listed"
Client County *
Please enter a valid county
Client Zip Code *
Please enter a valid zipcode
Client Age
Numeric age
Please enter a valid age
Client Phone Number
10 digits; numbers only
Please enter a valid phone number
Is the client, a spouse or child, or any other family member living with the client a veteran of the armed services? *


Please respond to this question


Who should we contact to arrange site visits for planning and ramp construction? *
First name
Please enter the contact's first name
Last name
Please enter the contact's last name
Contact Phone *
10 digits; numbers only
Please enter a valid phone number
Contact Email *
Please enter a valid email
Do we need to communicate with the contact in Spanish? *


Please respond to this question


Referring Agent Name *
First name
Please enter the referring agent's first name
Last name
Please enter the referring agent's last name
Referring Agent Agency *
Please enter the referring agent's agency
Referring Agent Phone *
10 digits; numbers only
Please enter a valid phone number
Referring Agent Email *
Please enter a valid email


What issues is the client facing because of not having a ramp? *




Please respond to this question

Is the client's condition temporary? *


Please respond to this question
If "yes", expected duration?

Per your agency's guidelines, does the client need financial assistance to get the ramp built? *


Please respond to this question

What kind of residence is the ramp needed at? *





Please respond to this question

Does the client rent or own the residence? *


Please respond to this question

Does the client own the land that the home sits on? *


Please respond to this question

Is there a need to remove/repair any existing structures in order to build the ramp required? *


Please respond to this question

Please provide any other relevant information, especially as requested above.

A copy of the information entered in this form will be sent to the contact email.