Client Referral Form | The Village Family Service Center

The Village Family Service Center

Client Referral Form

Referral form for health providers

Thank you for choosing The Village Family Service Center. We look forward to partnering with you in your patient’s care. For more information on our different programs and services, click the appropriate link below, or contact the office location that is most convenient for the client: 

Outpatient Counseling | Intensive Outpatient Program (Mental Health) | Addiction Treatment (First Step Recovery) | In-Home Family Therapy | Financial Counseling | Pregnancy Counseling | Adoption Services


To make a referral, simply fill out the form below. Once you've submitted this form, our Client Services Team will contact your patient to schedule an appointment with one of our Mental Health Professionals.