• Buckeye Central

• Bucyrus City Schools

• Ayersville 

• Defiance Elementary 

• Defiance Middle School 

• Defiance High School

• Fairview

• Outpatient

• Tinora

HPWO

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• Health Partners of Western Ohio

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• Navarre​

• Riverside

• Spring

• Westfield

Lucas County Children Services

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• LCCS Referral Form

• Academy of Excellence 

• Arlington 

• Beverly

• Birmingham

• Bowsher

• Chase

• DeVeaux

• East Broadway

• Edgewater

• Escuela SMART

• Glendale-Feilbach

• Glenwood

• Hawkins

• Larchmont

• Marshall

• McTigue

• MLK

• Navarre

• Old West End 

• Ottawa River 

• Pickett

• Riverside

• Rogers

• Rosa Parks 

• Sherman 

• Start

• Spring Elementary 

• TPS Virtual Academy

• Waite

• Walbridge

• Westfield

• Woodward 

Private Insurance

• Fill out this form if the client has private insurance.

• Arbor Hills

• Central Trail Elementary

• Highland Elementary

• Hill View

• Maplewood Elementary

• McCord

• Northview

• Southview

• Stranahan Elementary

• Sylvan Elementary

• Timberstone Jr High

• Whiteford Elementary