2026 Best Point Online Referral Form

Online Referral Form
If you happen to need assistance with this form, please contact Best Point's Centralized Intake Department at (513) 272-2800.
Date of Referral

MonthDayYear
Date
If referring a minor, was permission from parent/guardian received?
NOTE: Permission from the child's parent or guardian must be obtained before submitting this referral to Best Point.
Person Making Referral

First NameLast Name
Referrer's Phone Number
Format: (000) 000-0000.
Referrer's Email Address
Referring Entity
Name of school, clinic, hospital, agency, etc.; if the parent/guardian is making the referral, enter “Self”

Parent/Guardian Information
Does the County have custody of the child?
If yes, which county has custody?
Parent/Guardian/JFS Worker Name

First NameLast Name
Guardian relationship to Child (Note: If custody is not with biological parent or JFS custody paperwork will be needed before services can begin.)
Primary Phone Number
Format: (000) 000-0000.
Parent/Guardian Email Address
Parent/Guardian Street Address

Street Address

Street Address Line 2

CityState

Zip Code
Secondary Parent/Guardian Name

First NameLast Name
Relationship to Child
Secondary Primary Phone Number
Format: (000) 000-0000.
Secondary Parent/Guardian Email
Secondary Parent/Guardian Street Address

Street Address

Street Address Line 2

CityState

Zip Code

Online Referral Form