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Want to make a referral but prefer to speak with us first? Fill out our short referral form.

Call our Referral & Intake QuickConnect Line for more information or to make a referral.  After referral is completed, it will be assigned to staff as appropriate. Our referral process is a simple phone call that takes 5-10 minutes. Intake will be scheduled at the same time and our goal is to have intake completed within 1 week of referral!

Call Quick Connect at 453-4367 or 1-800-781-8550 ext. 2722
or, fill out our referral form below and we will contact you within 72 hours.

You may also download a copy of the referral form here, and email it to [email protected].


There was a problem with your submission. Please correct the issues below

Your Information

Basic Child Information

Parent Information

Best number to call

Guardian Information

(If applicable)

Best number to call

Referral Information

Include Provider Name, Agency Name, Address & Phone #

Child Information

How are things at home, school, etc.

Make referrals, school support, behavior management, etc.

Please check the box below before submitting.

Funded by State of Maine Department of Health and Human Services (DHHS) and MaineCare.