The referral form below is for individuals looking to refer themselves or individuals under their care for services. Please complete this form with the information for the individual being referred, whether that is for yourself or a child/children. If your child is 18 years old or older, they are legally considered an adult and consent will be required from that individual in order to proceed with services. If you are seeking family or couples counseling, please fill out the form with the information of only one member who will be attending the sessions. If you are seeking individual counseling for multiple family members, please fill out a form for each member being referred.

If you have any questions, please contact us.