39 years  of serving thousands of children ​& their families  throughout Franklin County and surrounding areas 

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community bEHAVIORAL health referral 


​Only clients with a Medicaid Insurance Plan as their primary insurance provider are eligible to receive mental health services by YAS. 
In order to ensure timely receipt of services all information must be filled out completely.         

PARENT/GUARDIAN INFORMATION

INSURANCE INFORMATION

CLIENT INFORMATION

REFERRAL SOURCE INFORMATION