All fields are optional, but be sure to include an email address or phone number if you would like a response.
She/Her He/Him They/Them Other:
Male Female Nonbinary Genderqueer Transgender Other:
Yes No
Parent/Guardian Client
Self-Referral Parent/Family/Friend School Court/Probation DHHS Other:
Vaping Nicotine Alcohol Marijuana Other Drugs:
Decision Making Assertiveness Skills Coping With Anxiety Goal Setting Other Skills:
Navigating Coming Out Educational Material Coping Skills Parent Support Other LGBTQ+ Topic:
Victim Bystander Bully
Triple P Ages 0–12 Triple P for Teens Triple P Stepping Stones PAX Community Tools
Children Living in a Chemically Dependent Home
Please provide a short narrative for the reason for referral (child caught using, seeking parenting classes, bullying instance, etc.).