Make a Referral

Sometimes it’s easier if we make the first call.

Especially when parents are overwhelmed with to-do lists, advice, brochures, and the stress that comes with caring for a struggling child. Our Family Peer Supporters are here to help. If you are a parent, and would like us to contact you please click ‘I am a parent…’ below to complete a brief self-referral form. If you are a service provider, please click ‘I am a service provider…‘ below to complete a brief referral form, which will require that you receive consent from the parent to share their information with us.

A PLEO Family Peer Supporter will be in touch within 5 business days and together we’ll determine how we can best be of help right now. As with all of our services, information shared here will remain confidential and secure.

Fields marked with an * are required – everything else is helpful, and not required for us to proceed.

I am a service provider and have received consent from a parent for PLEO to contact him/her directly
I am a parent, and would like PLEO to contact me

PARENT (1):

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Preferred Language

PARENT (2):

Preferred Language

CHILD OF PRIMARY CONCERN:

WHAT WOULD YOU LIKE US TO KNOW ABOUT YOUR CURRENT CHALLENGES?

REFERRING PARTNER:

*please indicate if verbal or signed consent was obtained, as per your agency requirements

Parent has consented to referral:*

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