Referral Form
Thank you for choosing Trusted Hands Consulting, a branch of HK LIFTED GROUNDS, CORP. Please complete this referral form. The parent/guardian will be contacted at the number provided within 72 hours of submission. 

We look forward to collaborating with you.

Howard C. Keller, MSW
CEO & Founder
929-385-1095
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How did you hear about us? *
Required

Referring Person/Agency

 *

Title/Role

 *

Phone Number

 *

Email Address

 *

Relationship to Child

 *

Reason for Referral

 *

Additional Information (Any relevant background information or special considerations)

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