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Client Referral Form

CEDARS staff member walking through the cafeteria with a young teen girl

Client Referral Form

I’m a professional and I need to refer my client to CEDARS services

Please note, online referrals made after regular business hours will be processed the next business day. If you need immediate assistance, please call 402-436-5437 to make a referral.

Is there a supervisor or other professional authorized to receive this information that should be copied on the response to this form? If so, please provide their email address here.

Your name

Your agency/organization name

Your agency/organization address (to ensure it's in our service area)

Your agency/organization phone number

Your email address

Preferred method of contact

Phone

What is your relationship with the youth/family?

Brief description of challenges/barriers

Names and ages of children involved

Areas looking for help in/programs interested in

Prevention Services including Healthy Families, Partners in Permanency, Sixpence, Community Response

Emergency Shelter

Outreach to youth experiencing homelessness

Other…

Has this youth/family ever received CEDARS services before?

Yes

This youth/family currently is involved in:

Juvenile Probation

Department of Health and Human Services

Will this youth/family need translation services? *

Yes

What is their primary language spoken?

Do you have a release to speak with us?

Yes

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Main Office

6601 Pioneers Boulevard, Suite 1

Lincoln, NE 68506

Omaha Office

10840 Old Mill Road Suite 200

Omaha, NE 68154

Phone

402-434-KIDS (5437)

Email

info@cedarskids.org

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