Best person to contact and relationship
Best way to contact (call, text, email)
Okay to leave voicemail message? YesNo
Phone number and/or E-mail address
Overview of Concerns
What support do you hope we can provide?
Anything else we should know to improve access?
What supports is your organization (and others) providing?
Check to confirm process has been followed: Consent attached (signed by parent/guardian(s) and youth older than 12 years old) – made out to Lutherwood/Carizon Mental Health Services
Referred youth/family is aware that Front Door is being contacted