Refer A Client

Teenage girls consoling their depressed crying troubled friend

Help A Child Get Connected

Know a child who may benefit from our services?

Please complete this form to provide us with more information about a child in your care. We will keep all the information you provide completely confidential, and a member of our team will respond to the contact provided.

We offer our services to girls and young women ages 8 to 21.

Click Here

Child's First Name

Child's Last Name

Child's Date of Birth

Enter City Child's Primary Residence

Choose State Choose State Ohio Child's Primary Residence

This Section is for Professionals/Guardians

Professiona/Guardian's First Name

Parent/Guardian's Last Name

Your Relationship to Child Your Relationship to Child Professional/Guardian

Diagnosis if Known

Professional/Guardian's Email Address

Your agency /organization

Professional/Guardian's Phone Number

Alternate Professional/Guardian's Phone

Preferred Method of Contact Preferred Method of Contact Phone Email Either

Type of Service In Which You Are Interested

Message

12 + 3 =

Send your mail at

Address

Help A Child Get Connected

Know a child who may benefit from our services?

We offer our services to girls and young women ages 8 to 21.

This Section is for Professionals/Guardians

Step Higher

Nella’s Place