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Complete our web-based referral form.

This pathway is the preferred method for Hamilton Center and is a digital version of the Hamilton Center Referral Submission Form.

All fields are required. Submissions that do not include a Parent Permission Form will not be accepted and may be required to re-submit.

This contact form is not for communications related to crisis. Inquiries will be received and responded to during general business hours - Monday thru Friday 8:00 AM to 5:00 PM. If you or someone you know is experiencing a mental health related crisis outside of these hours, please call 911 or Hamilton Center's Crisis Diversion Center 24-hr line at 800.742.0787.

Referral Information

Student's Name
Areas of Concern

Referrer's Information

Referrer's Name
What is the best way to contact you? *

Parent/Guardian Information

Parent's Name
I understand *
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