Lifeline Referral Information Checklist
We need the following details from you to ensure we provide the best service possible for your referral.
Can you please provide us with additional information?
- Client contact information (name, addresses, phone numbers) for all clients participating in services
- Referral Source contact information. Updated FCM contact information and Supervisor information
- The reason for the referral (Domestic Violence, Substance Abuse, Medical Neglect, Physical Abuse, etc.) Detailed information will help Lifeline correctly assign the referral in a timely manner.
- Any pertinent information (no contact orders, safety concerns, specific medical needs, any known allergies especially for the children, etc.)
- Location of visits (home, community, or office)
- How many hours per week of visit time
- The type of visits (fully supervised, intermittent/partially supervised). No unsupervised visits – Lifeline will not provide transportation only to visits.
- Dates when visits can start
- Transportation information. Who needs to be transported and who has dependable transportation
- The family’s availability. If the family is available during the daytime.
Do you have a question regarding a Lifeline referral? We’re happy to help. Please email referrals@lifelineyouth.org, and we’ll get back to you as soon as possible.