Refer a Youth to The Barry Robinson Center

Our Admissions team stands ready to answer your questions, assist with referrals, and provide specific information on The Barry Robinson Center’s programs and services.

All referral information is received and reviewed by the Admissions staff. We may conduct a pre-placement interview to obtain additional information regarding the youth’s needs.

Refer a Youth

"*" indicates required fields

Child's First Name

Child's Last Name

Date of Birth*

Gender*

What type of care are you seeking? (Select all that apply.)

Residential Treatment for Military-Connected Youth

Referent’s Information

Referent Relationship*

Referent's First Name*

Referent's Last Name*

Referent's Email*

Referent's Phone*

City*

State/Province*

Please provide a detailed message.

How did you hear about The Barry Robinson Center*

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Name

This field is for validation purposes and should be left unchanged.

Please contact us to learn more about our services or to refer a youth in need

Refer a Military-Connected Youth