• Get Started with Services

    Mental Health Client Initial Referral and Paperwork
  • Electronic Communication

    Please check the box below to consent for Sunbeam to follow up with regarding this referral and scheduling via email.
  • Mental Health

    Within the last 90 days (3 months) have you had a significant period in which you have:
  • Domestic Violence

  • Trauma

  • Substance Use

    During the past year, have you:
  • Pediatric Symptom Checklist (PSC)

    Please indicate that which best describes your child:
  • Adverse Childhood Experience (ACE) Questionnaire

    When growing up, during the first 18 years of life:
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    Pick a Date
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    Pick a Date
  • By submitting this document:

    I understand that completion of this document is for the purpose of determining client suitability for services and does not guarantee services provided by Sunbeam and that referral resources will be provided for those who do not qualify.
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