VS Referral For Services
Please complete this confidential referral for services below. This form will be sent directly to our Clinical Director and Client Services Supervisor and someone will contact the client as soon as possible to begin services.
Person making referral
Agency Contact Number
Agency Email Address
Date of Birth
Parent/Guardian Name (if applicable)
Okay to leave a message/say we're calling from Victim Services?
Reason for Referral/background
Grief Support Services
Healthy Relationships - A Comprehensive Abuse Prevention Program for Children
Victim Compensation Assistance Program
Trauma Sensitive Yoga
Suggested staff member
Tessa Boyles - Counselor
Erika Brosig, LCSW - Clinical Director
Tracey Cook - Senior Counselor
Brie Depcrymski, MA - Therapist
Marlene Finney, LCSW - Therapist
Natasha Fox, MA - Therapist
Jessica Hayes, LCSW - Therapist (Medical Insurance Only)
Nicole Otolinsky, MA - Therapist
Ashley Pribulsky - Counselor
Barbara Reing - Client Services Supervisor
Stephanie Rex - Lead Counselor
Heather Snyder - Counselor
Dale Thomas, LCSW - Therapist (Medical Insurance Only)
Marissa Whited - Child & Family Advocate
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