Please answer all of the questions below to make a referral to any of our services.
If you are requesting a referral for Targeted Case Management services ONLY, please complete the following forms along with the general referral form.
Kentucky Determination Criteria Checklist for Serious Mental Illness (SMI)
Kentucky Checklist for the Identification of Moderate to Severe Substance Use
Kentucky Checklist for Identification of Moderate to Severe Substance Use