Referral Forms

These forms are for use by third parties (e.g., school staff, caseworkers, physicians offices).

Thank you for considering us for your referral. We appreciate referral forms, so that we have information about the referral reason when a family contacts us. We do require that families contact us directly to request an appointment; we do not reach out to families based solely on a referral form from a third party. If you include a properly signed release of information with the referral, we will be happy to provide updates regarding the status of the referral. If the client is 14 or older, the client must sign the release (not the caregiver).

For information about current availability, please visit our Intake Request page. However, the form on that page should ONLY be completed by potential clients, not by third parties.