Are you a health, wellness or school professional looking to make a referral?
You're in the right place! Complete the form below and a team member will contact the family shortly.
Please be sure to ask the Parent's permission first before filling out this form. By completing and submitting this form, I am trusting that you have already done this.
*Note: Form is not encrypted and therefore not secure for HIPAA compliance. If you prefer, you can download a PDF version of the form and fax it to 203-429-8628 instead.