Forms

Lighthouse Child & Family Services Referral Forms

If you are a social worker or other professional making a referral for general therapeutic services, please secure a signed release of information from the parent or legal guardian and fax us the completed referral form to initiate the intake process. If you have any questions, please feel free to contact us at (320) 983-2335.

Release of Information

Intake Packets

Important – Email correspondence is not secure.  Given HIPAA privacy laws we ask that you please print the referral form and fax it to our offices at: (651) 342-8029. Thank You.