Referral Request Form
General Information:
The information is intended for referral purposes only. We do not warrant the information concerning any provider, nor do we license, endorse or recommend any particular provider. Only you can determine whether the quality of care is appropriate for your child.
All information entered on this form is confidential. Click on this link to view our Confidentiality Policy .
If you do not receive information within two business days, please resubmit or call (585) 654-4720.
For more information concerning any program that may be of interest, please visit ocfs.state.ny.us or call the Office of Children and Family Services at (585) 238-8531.
Fields marked with an * are required in order to process your referral.
For the most accurate referrals, all fields must be completed.