Impact Plus Referrals

To make a referral for a child for the Impact Plus program, simply fill out our referral form and fax it to our central office at (606) 679-1889. We look forward to the opportunity to work with you and your family!

  • If you have questions about the process or form, feel free to call our central office at (606) 676-0638 (office) and speak with one of our credentialed Case Managers. They will be happy to explain our program, the services we provide, and coordinate an intake date that works with your schedule. Click below to download the Impact Plus Referral Form, Print, Fill Out and Fax to 606-679-1889 or call one of our Case Managers at (606) 676-0638, they will be happy to explain our program and services.

    The Referral Form, click here→