For attorneys, courts, and agencies

Professional Referral Form

Complete this secure online form to refer a prospective client. Bright Beginnings will contact the client directly to discuss services and begin the setup process.

Referring professional

Referral dateProfessional nameAgency or organizationTitle or rolePhone numberEmail address

Prospective client contact

Client full nameRelationship to child or childrenPhone numberEmail addressBest time to callPreferred contactOther parent or participating adult

Child and case information

Child name or names and agesCountyCase numberCase typeCourt orderJudge or division

Service requestedBrief reason for referral and any court-ordered requirements

Safety informationKnown urgent safety concernsIf yes, briefly describe current restrictions, injunctions, violence, weapons, substance use, or other concerns

The prospective client is aware of this referral and may be contacted by Bright Beginnings.

Please provide only information needed for the referral. Do not include Social Security numbers, payment information, or medical records. See our Privacy Policy.