Referral Form
This form is for our community partners to complete to refer clients to one of HRC's services. The appropriate staff member will reach out to them directly, and to you, if there's any questions. If you have questions for us please call us at 218-844-8822. 
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Email *
Referred by (Name) *
Referred by (Organization) *
Referred by (Contact phone number) *
Client's Name *
Client's Phone Number *
Ok to Text Client? *
Ok to call Client *
Client's Date of Birth *
MM
/
DD
/
YYYY
Client Address
Please list children's Name, age and School *
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