top of page
Nichols Center
Living Plant Shop
Events & Groups
Family
Our Team
Partners & Sponsors
Community
Wellness Gardens
Suicide Intervention Training
Drug Disposal
Peer Services
Veterans & First Responders
Trauma Services
Referral
0
Submit Referral
REFERRALS
JOIN OUR PROGRAMS
Self Assessment & Referral Form
Please fill out the following form in order to participate in our groups or programs.
First name
Birthday
Phone
Email
Address
Do you have a mental health diagnosis/concern?
No
Mental Health
Substance Use Disorder
Dual Diagnosis
Suicide Attempt
Trauma/PTSD
Grief and Loss
Do you have a family member with a mental health diagnosis/concern?
No
Mental Health
Substance Use Disorder
Dual Diagnosis
Suicide Attempt
Trauma/PTSD
Grief and Loss
Have you been referred by a provider?
No
Therapist/Phychiatrist
Accountability Court
Court Services/Court Ordered
Community Program/Partner
Groups or Classes interested in attending:
Art Journaling
Addiction/Recovery Counseling
Anger Management
Community Service
Volunteer Opportunities
Trauma Support
Women's Wellness
Suicide Intervention Training
Veterans & First Responders
Mental Health Management
Transitional Housing Program
NAMI Mental Health Peer Services
Other Family Resources needed:
Submit
bottom of page
