Parent/Guardian Referral Form
You will need to submit the following information in order to complete the referral form:
- Psychological evaluation dated within the last two years
- Psychiatric evaluation dated within the last 60 days
- Psychosocial/Social History/Family Assessment
- Medical Evaluation/History & Physical with additional information required if the child has a major medical problem
- Recommendation letter from current physician/provider
- IEP (if special ed)
- Current medical insurance card
- Release of Information. To be legal, it must be completed entirety and must contain 2 signatures (parent/guardian or youth and a witness).
Please contact your mental health professional if you need help with this information. You should have these documents ready to upload before proceeding.