Toggle NavigationHomeAboutContactClient ReferralsTrainingHomeAboutContactClient ReferralsTraining Resolution Behavioral Health, LLC Resolving challenges one step at a time Client Referral Date*Referral Phone #*Referral Fax #Client Name(s):DOBClient AddressEmergency Contact Name and NumberInsurance Provider:Medicaid Number:Physician Name and Number:SERVICES REQUESTED:CounselingAnger ManagementSubstance Abuse CounselingParentingFamily/Community SupportDrug AssessmentREASON FOR REFERRAL/TREATMENT:This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service. Send MessageThank you for contacting us. We will get back to you as soon as possible / PreviousNextPausePlayClose