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KIDS NW Behavior Services Referral

Please submit this referral form to begin the process of enrolling a member in KIDS Behavior Services. Once we review your referral, the KIDS NW Behavior Team will connect with the Service Coordinator for any additional documentation needed. We will be in touch with you soon!

*This form is secure and HIPAA compliant. If there are any questions or concerns feel free to contact us at (503)-437-4917 or

  • Max. file size: 256 MB.
  • 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
  • This field is for validation purposes and should be left unchanged.

Note: Service Coordinators can send OR-570 or OR-310 Service Agreements to:

SPD #103461

Join Our Community!

Have questions or want to learn more about our services? Contact us online or give us a call at Office: (503) 437-4917 or Toll Free: 1.888.360.0360

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