El contenido de esta página requiere una versión más reciente de Adobe Flash Player.

Obtener Adobe Flash Player

The levels of care recommended to a consumer are determined by a multidisciplinary team that includes a psychiatrist, a nurse, licensed counselors, master level clinicians and certified addiction counselors.
continue reading »
Intensive Family Intervention services are short-term, family-focused, and community-based services designed to help families cope with significant stresses or problems that interfere with their ability to nurture their children.
continue reading »
ProActive Management Consulting, LLC – Counseling and Advocacy Services Division (PMCCAS), is a certified Comprehensive Child and Family Assessment (CCFA) independent provider for all 159 counties in Georgia.
continue reading »
Wrap-Around Services may be used in combination or as separate service components. The purpose of Wrap Around Services is to demonstrate improved outcomes in the safety, permanency and well-being of children and families.
continue reading »
We offer a wide variety of personalized individual & family counseling services.
continue reading »
Prime for Recovery DUI program is designed to assist individual that has DUI charges and require either a Clinical Assessment or a Treatment Provider services to meet the requirements for licensure reinstatement.
continue reading »

Referral Form

Please, complete this form:

Date:
 
Child Information:
Consumer #1 Medicaid# SS# DOB /
Consumer #2 Medicaid# SS# DOB /
Consumer #3 Medicaid# SS# DOB /
Consumer #4 Medicaid# SS# DOB /
Consumer #5 Medicaid# SS# DOB /
 
Name of Parents/Guardians:
Address: City: Zip Code:
Home #: Cell #: Work #:
Diagnosis:
Hospitalization History:
Medications:
Legal Issues:
 
Reason Child is being referred:
Truancy Disruptive Behavior Sign of Depression Anger Issues
Academic Issues Multiple Detentions/Suspensions Grief/Loss Substance Abuse
Adult CORE Groups Other
 
Referral Information:
Referred by: Title:
Contact Email: Phone number:
Probation Officer: Next Court Date:
School Name: Date:
Referral Source made
contact to Parent?
   
 
Proactive Team Only:
Parent contacted: Date: Made contact: Mailed Letter: