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REFERRAL FORM

A variety of free and low cost programs are available to qualifying individuals through KidsFirst. 

Please complete the form below and click submit at the bottom of this page

PLEASE PROVIDE THE FOLLOWING CONTACT INFORMATION:

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If making a referral for someone other than yourself, please complete this section so that you may be contacted

REQUIRED, PLEASE COMPLETE:

FOR OFFICE USE ONLY:

ENGAGEMENT LOG:

Please complete below for any contact and/or contact attempt and document in Persimmony.
Thank you for submitting your referral. Please anticipate a call within 3 business days. If you do not receive a call or have any questions, please contact us.
*The referral cannot be successfully submitted until all noted areas are completed above.

KidsFirst Counseling & Family Resource Centers

We are a non-profit, community-based organization operating counseling and family resource centers which empower, educate and strengthen families through prevention, early detection, intervention and treatment programs. All services are free, confidential & available in English & Spanish.

  • Call Us at (916) 774-6802
  • kidsfirst@kidsfirstnow.org

KidsFirst
Roseville

124 Main Street
Roseville, CA 95678
Tel: (916) 774-6802
Fax: (916) 774-2685

Office Hours:
Monday to Friday
9:00 a.m. to 5 p.m.

KidsFirst
Auburn

11960 Heritage Oaks Place, Suite 3
Auburn, CA 95603
Tel: (530) 887-3536
Fax: (530) 887-3856

Office Hours:
Monday to Friday
9:00 a.m. to 5 p.m.

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