Referral to FORTUNA 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.
Sign in to Google to save your progress. Learn more
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?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Boys & Girls Club of the Redwoods.

Does this form look suspicious? Report