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SCARF Provider Dashboard

SCARF Provider Dashboard
SCARF Provider Dashboard

Online Referral Request Form

Step 1 of 4

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  • Priority Need and Referral Information

  • MM slash DD slash YYYY

  • Client Information

  • Reason for Referral (may check more than one service):

  • Insurance Information

  • Special Request: (For all special request, please include a signed release of Information)

  • Drop files here or
    Accepted file types: pdf, docx, jpg, gif, png, xlsx, Max. file size: 100 MB.

    • Case Guidelines

    • Child Welfare Referring Agency Information

    • Family/Placement Information

    • Household Size:#Adults:#Children:DCF Case #:
    • NameAgeRelationship to Client 
      Select the + at the right to add additional rows

    • Request for Evaluation and/or Services:

      *EVALUATION: If you are requesting an evaluation, please be specific about what incident led to the referral and what you hope to learn from the evaluation. **SERVICE: If this referral is for one of our specialized treatment programs (i.e. ESM or Y-SAPP), please list what symptom(s) or concern(s) you would like to address, such as caregiver protective capacity or sexual harm by youth.
    • This field is for validation purposes and should be left unchanged.

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