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:

• The Child and Family Counseling Center (including the Preschool Outreach Program)
• The Hyde Park and Park Street Community Service Agencies
• Safe at Home

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 intake@thehome.org

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

• Central Intake
• 1-855-240-4663
• intake@thehome.org