Child Mental Health Referral Form Guide
This should be read before filling out a referral form for a higher level of services than once a week outpatient counseling. This document will explain the purpose of the referral form as well as guide a referral agent on how to fill out the form properly.
Child Mental Health Referral Form
This form is to be filled out if a child meets the eligibility requirements for receiving services from the Division of Child Mental Health and might need a higher level of services than once a week outpatient counseling. This form has to be printed out and filled out manually or the form can be filled out electronically here.
Child Mental Health Referral Form (Spanish Version)
This is the Spanish version of the referral form.
Child Mental Health Referral Form (Electronic Version)
This form will allow the referral agent to type the information into the form as well as email the form to individuals as an attachment if they feel input is necessary from another source e.g., school, therapist, parent; however, when the form is completed it must be printed out and physically signed by the parent.