Adolescent Referral Form - The Phoenix Center 2026

1. Click ‘Get Form’ to open the Adolescent Referral Form in our editor.
2. Begin by entering the 'Date of Referral' at the top of the form. This helps track when the referral was made.
3. Fill in the 'Client Name' and 'SS#' fields accurately to ensure proper identification.
4. Provide details for 'Parent/Guardian Name' and 'Parent Phone' to facilitate communication.
5. Complete the 'Referring Agency' and 'Referring Agent/Phone' sections to identify who is making the referral.
6. In the 'Reason for Referral', clearly state why the client is being referred, including any pending charges if applicable.
7. Check appropriate boxes for recommended services such as AOD Assessment or Behavioral/Mental Health Assessment.
8. Ensure you have all necessary documents ready for your appointment, including photo ID and insurance cards, as listed on the form.

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