Confidential Referral Form
If you are experiencing a life-threatening emergency, call 911 immediately.

The confidential referral form supports individuals and families before and during a crisis. Complete the form to be connected with the appropriate staff. 

Request are reviewed on a rolling basis. You should expect to hear from us within 48hours.

Complete the form to the best of your ability.  The more details you add the better.

Thank you 
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This form was created inside of Restorative Justice for Oakland Youth. Report Abuse