Teen CARE referral form

Teen CARE services

Teen CARE is here to provide support, guidance, and education. Please let us know if you'd like to learn more about Teen CARE's counseling or prevention programs by filling out the information below. If so, we will reach out to you to discuss, and together we can see if Teen CARE would be a good fit for you. Your personal information will be kept confidential.

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* 1. I am interested in learning more about Teen CARE counseling services.

Yes

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* 2. I would like to learn more about Teen CARE prevention services:

Yes

If you checked of "NO" to 1 and 2, skip the contact information and go to "Done."

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* 3. If you you checked of "YES" to learning more about Teen CARE's counseling or prevention services, please let us know how to contact you below. If you do not want us to reach out to you, leave the contact information blank.

Your First and Last Name:

Your School:

Your Email:

Your Cell Number:

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* 4. Please feel free to share any additional information or comments.

Thank you and be well!