Making a Referral to Family Guidance Center

We strive to make the referral process as easy and time efficient as possible.

THere are a few ways you can make a referral:

  • Request that the client contact the office at (216) 731-8815 or (216) 409-8525,

    with the necessary information.

  • Download and print the referral form here and simply fax it back to our office at (216) 731-8816.
    Doing this ensures that the client is mailed program information within 24 hours. We will keep the referral open for 3 months while continuing to encourage the referred client to get involved with the appropriate program and/or services. During that time, we will keep you informed via a hard copy report faxed to your office so you have accurate information regarding your client’s progress.

  • Fill out the web Referral Form below:


 

Referral Form

Client's Name *
Client's Name
Phone Number: *
Phone Number:
Fax Number:
Fax Number:
Referring Agency Address
Referring Agency Address
Please check which program(s) the client needs to attend: *
Client Approval *
By checking the following box you are agreeing that the Client has read the above form and agrees to the accuracy of the information presented.
Referring Person's Approval
By checking the following box you are agreeing that the Referring Person has read the above form and agrees to the accuracy of the information presented.
Today's Date *
Today's Date
 

IF YOU ARE A PHYSICIAN OR AGENCY:

We ask that you send over pertinent information or records before the patient’s appointment.  Mail, (time permitting), to Family Guidance Center, 25000 Euclid Avenue, Suite 406, Euclid Ohio 44107; fax to (216) 731-8816; or send via e-mail to familyguidancecenter @earthlink.net.

IF THE CLIENT IS A MINOR:

Parents and/or guardians must attend all appointments with their minor child.  We ask that the parents and/or guardians bring all pertinent medical and/or psychiatric information, i.e. doctors’, therapists’ names, addresses and phone numbers.