Follow the steps to complete your Treehouse Psychological Services referral form.

1. Press the ‘Get Form’ button to access the referral form and open it in your preferred online editor.
2. Fill in the 'Today's Date' and provide your full name as the person completing the referral form. Specify your relationship to the child for context.
3. Choose the appropriate assessment services requested by marking the relevant boxes for the type of psychological evaluation required.
4. Enter the child's information, including their name, gender, date of birth, social security number, Medicaid number, and private insurance details.
5. Indicate the child's current living situation by selecting one of the options provided, such as foster home, adoptive family, etc.
6. Provide the family caregivers' names and addresses, including street, city, state, and zip code.
7. Input relevant contact numbers for the family, including home, mobile, and work phone numbers.
8. Complete the section on Child Protective Services information, providing your caseworker's details, including their name and contact information.
9. Answer the question regarding previous psychological evaluations and note their completion date if applicable.
10. Provide detailed information about the child’s needs, marking any requirements for interpreters or special communication, and list current symptoms.
11. Ensure you have all necessary documents, including the completed referral form, the signature page of the Treatment Agreement/Informed Consent, and the Texas Notice Form.
12. Sign and date the form as the parent or legal guardian and indicate your relationship to the child.
13. After completing the form, you can save your changes, download, print, or share the form as needed.

Complete your Treehouse Psychological Services referral form online today to facilitate the support your child needs.