Printable Referral Form
Please download the referral package below, fill out completely and fax back to us at (807) 623-5588:
Ka-Na-Chi-Hih Referral Package
Includes:
- Youth Services Intake Form
- Medical History
- Voluntary Program Participation Agreement
- Pre-Admission Agent Agreement
- Authorization for Release of Information
- Client Medical Information
Click Here - PDF format
