Submit a Referral

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K.I.D.S. NW Behavior Services Referral

This referral form is intended to begin the process of enrolling a member into KIDS Behavior Services. Once this form has been received, a member of the KIDS NW Behavior Department will contact the Service Coordinator to request additional documentation and service agreements if this appears to be a good fit. *This form is secure and HIPAA compliant. If there are any questions or concerns feel free to contact us at (503)-437-4917 or info@kidsnw.org

  • Max. file size: 256 MB.

  • By submitting this form I understand that I am authorizing the following: *KIDS, LLC to contact me about services. *For KIDS, LLC to share any pertinent information, history, and documentation with the Direct Support Professional that I have selected to provide services so that they are educated on the care that is needed. I understand that I may revoke this approval to share information by emailing Info@kidsnw.org.
  • This field is for validation purposes and should be left unchanged.