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Refer a Child or Family

Thank you for thinking of this work for a child or family you know. Please keep this initial inquiry general. Do not include confidential, medical, or identifying information about a child here. Once I follow up, we can discuss next steps privately.

Your name

Your email

Your profession or practice

Do you work directly with children in your practice?

Do you work directly with children in your practice?
A
B
C

What is the general reason for this referral?

Please describe in general terms only. No names, diagnoses, or identifying details.

Is there a specific timeframe or urgency?

Is there a specific timeframe or urgency?
A
B
C

Best way and time to reach you

*We store your information securely in a private spreadsheet via Tally and only use it to reply to your inquiry. View our Privacy Policy for details.

*We store your information securely in a private spreadsheet via Tally and only use it to reply to your inquiry. View our Privacy Policy for details.