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Interested in TM services ?

Make a Referral  

Easily refer a child or family to our therapeutic mentoring services using the downloadable referral form below or over the phone.

This form is ONLY applicable to the following programs:

How to make a referral:

  1. Download the Intake Referral form (Word .docx file)
    Microsoft Word or a free alternative like OpenOffice is required.

  2. Fill out all the form fields ON YOUR COMPUTER. Please be as detailed as possible regarding current concerns and behavioral issues. If you are printing the document, please be sure that writing is legible.

  3. Save/Scan the completed form to your computer and email it to

  4. To place a referral by phone, please contact FAM at ​(774) 257-5595.​​

* The referral turnaround time is between​ 2-5 business days.

If you have any questions about referrals, please contact us:

(774) 257-5595 or

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