RESTORE Program Referral Form
Submit a referral for our evidence-based program for adolescents ages 12-17 with problematic sexual behaviors.
Program Eligibility Criteria
Youth May Be Appropriate For the RESTORE Program If They:
- Are typically between ages 12–17
- Have engaged in problematic sexual behaviors
- Have been referred by courts, DCS, probation, schools, or families
- Are able to participate in structured therapeutic sessions
Youth May Not Be Appropriate If:
- Active psychosis is present
- Severe intellectual disability prevents participation
- Behavior requires secure residential treatment
- In such cases, an appropriate referral will be recommended.
Submit Your Referral
Please provide comprehensive information to facilitate an appropriate intake process. All fields marked with an asterisk (*) are required.
Thank you for submitting the referral. We will review the information and contact you shortly to discuss the next steps.
There was an error submitting your referral. Please check the form and try again, or contact us directly.
Questions About the RESTORE Program?
Contact us directly to discuss referral procedures, program details, or program suitability.