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The Parenting PATH Referral Form
Thank you for your interest in The Parenting PATH.
For more information about our agency or our programs, please visit:
www.parentingpath.org
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Email
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Your email
Date
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/
DD
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YYYY
Program(s) I am referring to:
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Fathers Are Parents Too (Guilford, Forsyth counties)
Family Support (Forsyth, Stokes counties)
Family Transitions & Co-Parenting (Forsyth, Stokes counties)
GREAT Forsyth (FTCC only)
Intensive Family Preservation Services (IFPS)
Knock Out for Change (Forsyth county)
Let's Talk Parenting - a Triple P Discussion Group
Parent Aide (Forsyth county)
Parent Coaching
Parent Support (Stokes, Surry counties)
Parent/Teen Solutions (PTS) (Forsyth county)
Parent/Teen Solutions (PTS) (Stokes, Surry counties)
Peaceful Alternatives to Tough Situations (PATTS) (Forsyth county)
Positive Effective Parenting (PEP) (Forsyth, Stokes counties)
Respite Care Services (Forsyth county)
Sexually Reactive Therapy
Supervised Visitation and Monitored Exchange
Trauma-Focused Therapy
Welcome Baby (Forsyth county)
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Name
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Agency
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Email Address
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Phone
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Relationship to family
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Is there a signed Release of Information on file?
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No
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Has the family been informed of this referral?
(We find that families are more likely to participate if they are expecting our follow-up.)
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