Forms

CBH Forms

Release of Information Form*

*A signed Release of Information is required for coordination of services.

Child & Adolescent Services and Greater Williamsburg Child Assessment Center GWCAC) Forms

If you are a community agency, school or other provider referring a child or adolescent to Colonial Behavioral Health's Child & Adolescent Services or the Greater Williamsburg Child Assessment Center (GWCAC), please use the two forms below to make a referral.

After completing these two forms and obtaining the required signatures, fax the completed forms to 757-253-4197.

School-Based Referral Form

Healthcare Provider Referral Form

Release of Information Form*

*A signed Release of Information is required for coordination of services.

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