Intake Inquiry Form

*Please note if your child/ teen is expressing severe at-risk behaviors or thoughts of harming themselves or others, Outreach’s services will not be a good fit. It is recommended that Resolve Crisis Services is contacted at 1-(888)-796-8226. Outreach does not offer crisis services and will advocate for what is in the best interest of your child/ teen.

Payment options

Security Code (*click on image to refresh):

Please enter the Security Code (*lowercase letters):

Submit