Counseling4Kids Referral Form 2024 - English Logo
  • Referral Form

    Glendale: (818) 441-7800 / Fax: (818) 662-6968

    Torrance: (310) 817-2177 / Fax: (310) 817-2178

    Email: referrals@counseling4kids.org

     

    • Biological Parent 
    • MEDI-CAL 
  •  / /
  •  / /
  •  / /
  •  / /
  •  / /
  •  / /
  • School Referral | Documents needed:

    • Signed Consent Form
    • Custody paperwork (if applicable)
    • Child's Medi-Cal Card
    • Copy of driver's license or I.D.
  • Voluntary | Documents needed:

    • Custody paperwork (if applicable)
    • Child's Medi-Cal Card
    • Copy of driver's license or I.D.
  • Court Ordered | Documents needed:

    • Minute Order, Stand Alone, Or MH-179
    • Detention Report (if available)
  • MAT Referral | Documents needed:

    • Copy of MAT Assessment
    • Summary of Findings
    • CANS
    • Court documents
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Image-46
  •  
  • Should be Empty: