Referral to YOUth Choose: Brief Interventions for Substance Using Adolescents
YOUth Choose is brief intervention for substance using adolescents. 2 sessions, with an additional optional parent/guardian session.
We just need a contact phone number and we will then call to schedule the youth once we have their number.
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THIS IS NOT A TEEN COURT REFERRAL.
If you want to make a Referral to a Teen Court Hearing, please use the proper TEEN COURT Referral Portal on our Website.
Are you aware that this is a referral to YOUth Choose: Brief Interventions for Substance Using Adolescents?
 *
Who is the referring agency? *
Referral Agent's Name *
If first time referral, Referral Agent's phone and email address *
Name of Youth (First and last names) *
Youth's phone number *
Parent/guardian's name *
Phone number of parent/guardian *
Parent/guardian's email address *
Anything else? *
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