Make A Referral

For county caseworkers, juvenile courts, hospital discharge planners, schools, physicians and community providers. Attach what you have; we’ll tell you what’s missing.

Need help with a referral?

Referral Checklist

Please provide as many of the following documents as possible to help us process your referral quickly.

Most recent diagnostic assessment or psychological evaluation
Current medication list and prescriber contact
Court orders, custody documentation or guardianship papers
Placement history and reasons for previous disruptions
Insurance or funding authorisation details
IEP or current school records for youth referrals

Need an Emergency Placement?

Call our admissions team 24/7 for immediate placement assistance. Complete the referral form afterward so we have the required documentation on file.

Referrals inbox

referrals@sinceretreatment.com

Referral form

All fields marked * are required.
We strive to review referrals within 24 hours.

Program requested *

Urgency *

Your name *

Organisation *

Your role *

Referral source type *

Email *

Direct phone *

Client initials *

Age *

Use initials only in this form. Full identity is
collected on the secure intake call.

County of residence

Presenting concerns & clinical summary *

Supporting documents

A signed release of information is in place, or will be provided before any protected health information is exchanged. *

All referral information is kept confidential and securely transmitted.

Make a referral

Need help with a referral?

Referral Checklist

Need an Emergency Placement?

Referrals inbox

Referral form

Agency

Programs

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