Referral Form

  • Thank you for making a referral to Garland Oaks. We look forward to speaking with you and hope we can make this process as smooth as possible for you and the youth you are assisting. Before we get started, let's make sure the youth is within the population we are able to serve:

    Youth is between the ages of 12-17, biologically and gendered female at birth, and not a threat to herself or others. 

  • Today's Date
     - -
  • Format: (000) 000-0000.
  • Please describe yourself as the person submitting this referral:*
  • Current Age of Survivor*
  • Do you know the survivor's date of birth?*
  • Date of Birth
     - -
  • What is the custodial status of the youth?
  • Do you know if she recognizes the trauma she has experienced and identifies as a victim of sex trafficking?*
  • Has your client been identified as a survivor of sex trafficking?*
  • Length of time in this location:*
  • Is she safe where she is located?*
  • What are the main symptoms/concerns?*
  • Any known mental health issues?*
  • Does she have any known developmental disabilities or special needs?*
  • Any known safety concerns?*
  • Rows
  • Does she have an IEP (Individualized Education Program)?*
  • Is the location of the trafficker known?*
  • Do you know if her trafficker used drugs as a form of control?*
  • Has there been drug use that would cause her to need detoxification prior to coming to Garland Oaks?*
  • Are there any known threats of violence or retaliation by her trafficker/family/significant other?*
  • Do you know if she has recruited or has shown interest in recruiting others into "the life"?*
  • Is she currently a flight risk?*
  • Does she know you are making a referral to Garland Oaks?
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