• Children's Behavioral Solutions

Children’s Behavioral Solutions Patient Referral Form


 Name of person completing this form:













Legal Guardian Information:















Name of Person Being Referred:






Background Information:






















Current Psychiatric Diagnosis:






Educational Information:








Healthcare Information:

















Our National Placement Services
  • Children's Behavioral Solutions
  • Military & Family Support Services
  • Treatment Placement Specialists

Our National Affiliations & Organizations
  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • National Alliance on Mental Illness (NAMI)
  • National Association of Addiction Treatment Providers (NAATP)
  • The Joint Commission (JCAHO) Gold Seal of Approval
  • The Jason Foundation

A Message from our CEO

COVID-19 Update