Extend a Helping Hand
Refer a Family to Dawn Health

Unlock Comprehensive Mental Health and Wellness Support for Families

Institution Location State

Institution Location City

Institution Name

Please Select

Will your institution be covering the cost for this individual/family?

Referring Case Manager/School Counselor/Physician

Contact Phone

Contact Email

Full Legal Name

Month & Year of Birth

Residence State

Residence City

Full Legal Name

Email Address

Phone Number

Reason for Referral (Select all that apply)

Please Select

Urgency of Follow-up Required

Brief Summary of the Child's Current Health Status

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Nurturing mental health resilience in adolescents for a stronger future.

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If you, anyone in your family, or someone you know is in crisis, call 911 or go to the nearest emergency room.

Dial 9-8-8 to reach the 24-hour National Suicide Prevention lifeline.

Text HOME to 741741 to reach the Crisis text line.