Make a Referral

Easily refer a child or family to one of our community-based services using this downloadable referral form.

This form is ONLY applicable to the following programs:

How to make a referral:

  1. Download the Central Intake Referral form (Word .docx file)
    Microsoft Word or a free alternative like OpenOffice is required.

  2. Fill out all the form fields ON YOUR COMPUTER. Please be as detailed as possible regarding current concerns and behavioral issues.
  3. Save the completed form to your computer and email it to

If you have any questions about referrals, please contact us:
Central Intake