Third Way Center’s admission process begins with completing the below referral form. Please complete the form and email it along with the following supporting documents. For our community based programs (York, Pontiac, Bannock, and Lincoln), please send the completed referral forms to Dave Eisner at email@example.com. For staff secure referrals, or if you are unsure which program to refer to, please email Amber Lacy at firstname.lastname@example.org.
In addition to the above Referral Form, we require the following documentation for admissions:
- Psychological/Neuropsychological Evaluations and all testing, including IQ/IEPs
- If youth is offense specific; History and Maintenance Polygraphs, Monthly Treatment Reviews/updates of previous treatment
- Placement history and discharge summaries from previous placements
- Family Treatment/ Service Plan
- Any medical information that may pertain to their mental health
- Health Passport (date of last physical, dental, vision and immunization records)
- Legal History
- Trails ID, copy of Birth Certificate, Social Security Card or number and Medicaid numbers (MUST HAVE PRIOR TO PLACING YOUTH)
For the full Admission Packet, please use the button below.