Referring a Client

Making A Referral

All referrals must come directly from Child Welfare Services, our community partner agencies, a child’s school or their pediatrician. If you are a caregiver and are seeking services for your child, please contact one of these providers and request a referral be made on behalf of your child.

The Tree House Child Advocacy Center of Montgomery County, MD can assist in making a referral to an appropriate community provider as appropriate.

Date of Referral

Agency and Department requesting mental health services:

Social Worker Name

Social Worker Email

Social Worker Phone

Client Name

Client DOB

Client Address

Brief History

Date of last known abusive Incident:

Date of forensic Interview:

Name of Legal Guardian

Phone # of Legal Guardian

Preferred language of client:

Preferred language of caregiver

Insurance info, if any

Alleged Maltreator’s name

Alleged Maltreator’s DOB

Current whereabouts (if known)

Scheduling an Appointment

When a referral is made by Child Welfare Services or law enforcement, our community partner agencies, a child’s school, or their pediatrician, the caregiver will be contacted directly to schedule a brief phone screen and then an intake appointment. At the intake appointment we will meet with you and your child and determine what therapy services are needed.

Referring a Client

Making A Referral

Scheduling an Appointment

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