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Insurance Displacement Housing – Claim Intake

Submit a claim below and a placement specialist will respond within 24–48 hours (sooner for emergency requests).

24/7 Line:Email:

Section 1: Claim Information

Loss Type
Date of Loss
Month
Day
Year
Estimated Length of Stay

Section 2: Adjuster Information

Adjuster Type
Preferred Method of Contact

Section 3: Policy Holder Information

Section 4: Housing Needs

Pets?
Yes
No

Accessibility Needs

Section 5: Preferred Housing Details

Housing Type

Furnishing Level

✔️Fully Furnished (Standard)

Section 6: Billing & Authorization

Billing Preference
ALE / Per Diem Guidelines Provided?

Section 7: Urgency & Placement Timeline

Placement Urgency

Section 8: Document Upload (Optional But Powerful)

Estimate/ Scope

ALE authorization

Claim Summary

Special instructions

Section 9: Confirmation

By submitting this form, I confirm that the above information is accurate and authorize Tidewater Housing Solutions to coordinate temporary housing related to this insurance claim.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date
Month
Day
Year

Submissions are monitored 24/7. A placement specialist will respond within 24–48 hours (or sooner for emergency requests).

Optional Form Logic (Highly Recommended)

If Pets = Yes, show pet details field


  • If Direct Bill, show billing contact section


  • If Emergency, trigger auto-email + SMS alert

What Happens Next

  • Your request is reviewed immediately

  • Housing options are sourced based on ALE guidelines

  • Policyholder is contacted for coordination

  • Placement is completed and documented

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