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Referral Form

Please provide only contact information that is safe for Eden Centers to use. If phone, text, voicemail, or email contact could place you at risk, please indicate the safest way and time to contact you below

- Confidentiality has legal limits.

- Do not share information you do not feel safe sharing.

- This form is not for emergencies.

- Adult trafficking disclosures are not automatically reported to law enforcement without consent unless a legal duty or safety issue applies.

- A separate release is required before sharing identifying information, unless disclosure is required by law, necessary for immediate safety, or otherwise legally permitted.

By clicking "Next," you acknowledge that you understand the purpose of this form, the limits of confidentiality, and that you wish to continue the referral form voluntarily.