This referral form is for individuals looking to refer themselves or individuals under their care for outpatient counseling services. Please complete the form with the information for the individual being referred, whether that is for yourself or a child. If your child is 18 years old or older, they will need to complete this form themselves 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 person who will be attending the sessions. If you are seeking individual counseling for multiple family members, please fill out a separate form for each person.
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