New Student Referral Form
Parent must be informed of the referral being made to M2M prior to the submission of this form
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Referral Source (name, title, relationship to student) *
Your Email *
Your Phone Number
Name of Student (please include age and grade level) *
Home Campus of Student (Alternative School) *
Name of legal guardian (parent) *
Parent phone number(s) *
Parent or Guardian's email(s)
What are the presenting issues?                                       Confidential fax: 281-972-8285
What are best times to meet with the student on Campus?
Disclaimer (Please Read)
We recommend meeting with the student on campus (counseling department) or at the M2M main offices at the address provided below.  The campus counseling center is ideal for the convenience of the students.  We also offer virtual sessions which we do not recommend for students under the age of 18.

You will receive an individual email confirming a team member from Minor to Major has received your referral within 48 hours of your submission. Please be sure to make appropriate documentation or follow up with an email to with your name and the student's name included on the email.

The Intake Department will then assign the student to a therapist who will then contact guardian before making the first contact.  All intake forms and required documents will be signed by an authorized legal representative of the student prior to a professional staff member from M2M contacting the student.

Minor to Major LLC main offices located at
11811 N. Fwy Suite 500
Houston, Texas 77060

* By providing your contact information above you give Minor to Major LLC authorization to contact you in matters associated with the referral given.
* The parent/legal guardian of the student referred for services has been notified of this current referral
* All the information you provided on this referral form is true and accurate to your knowledge
If you understand and agree to the above statement, please select the appropriate response below *
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