Referral Form Please know that this link is not intended for emergency referrals. If you or a family member are experiencing a mental health emergency, please call 911 or go to the local hospital emergency room. Please enable JavaScript in your browser to complete this form.Who are you referring?My ChildA child of whom I have custodyI am from an agency + working with a childYour Name *FirstLastYour Email *Referral Agency (if applicable)Mental Health Agency with whom my family is workingYouth Name *FirstLastYouth Date of BirthLegal Guardian Name *FirstLastLegal Guardian Phone NumberRelationship of Legal Guardian to YouthYouth AddressAddress Line 2 CityState / Province / RegionZIP / Postal Code *Youth County/RegionSummitDoes the Youth have Medicaid?YESNOIf yes, enter their Medicaid number:The youth's legal guardian will be contacted directly regarding services. Please provide the best contact number above.Submit Call our 24/7 Crisis Hotline anytime 330-784-7200 Safe Landing +1 330-784-7200 a.christy@sheltercareinc.org The Highlands +1 330-633-9474 m.dotterer@sheltercareinc.org Street Outreach 1 234-571-2807 n.woodley@sheltercarinc.org Respite & Shelter Home +1 330-630-5600 h.roper@sheltercareinc.org