Forms

INSTRUCTIONS:

Please complete all forms in their entirety. Any questions should be directed to Melissa Baughn at mbaughn@co.greene.oh.us or Brent Lewis at blewis@co.greene.oh.us. Some forms may be submitted online. Others can be emailed to mbaughn@co.greene.oh.us, faxed to 937.562.5601 or delivered to 158 E Main Street, Xenia OH 45385. 

NEW CLIENT FORMS

All new clients should complete the New Client Packet in its entirety and submit supporting documentation. 

REFERRALS

Our High-Fidelity Wraparound (HFWA) program uses an intensive, team-based, person-centered, care, planning and management process. It is most effective for those with complex needs and a history of service utilization. 

The criteria for service includes: 
* Youth living at home with substance abuse, mental health, juvenile justice or serious behavioral or emotional disorders.
* Youth experiencing homelessness or at risk of becoming homeless.
* Families at risk of youth's custody being relinquished.
* Youth deemed or at-risk of becoming unruly or delinquent.
* Service must be sought voluntarily. Parents and guardians must be actively involved in the treatment plan.

Referrals are accepted from agencies, medical or mental health professionals or self-referral. Please complete the referral packet in it's entirety including attaching supporting documentation. Some documents are available in two forms, one to be printed and completed or one to be completed and submitted online.