Devereux Florida: Admissions and Referrals

Devereux Florida open positions - you will be redirected to our Foundation site.

Home >> Admissions

Devereux Florida
Admissions/Referrals

The Devereux Florida Central Referral Unit (CRU) can be reached by either filling out the form below, calling 1-800-DEVEREUX (1-800-338-3738) 24 hours/day, 7 days/week, or if you prefer contact us via e-mail by clicking here.

Devereux does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status or any other characteristic protected by law.

Question - Not Required - Client Name:

Question - Not Required - Date of Birth:

Month

Day

Year

Question - Not Required - Gender:

Question - Not Required - IQ:

Question - Not Required - Legal Guardian:

Question - Not Required - Please describe any legal issues:

Question - Not Required - School grade:

Question - Not Required - School classification:

Question - Not Required - Please describe problem behaviors and reasons for residential treatment:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Any Substance Abuse? Describe:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Has the child suffered physical/emotional or sexual abuse? Describe:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Previous Treatment:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Diagnosis:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please describe any health concerns:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Please provide names of current psychotropic medications:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Describe family and living situation:

Question - Not Required - What kind of funding is available for residential care?:

(Maximum response 255 chars, approx. 5 rows of text)

Contact Information:

Name:

First Required	Last Required

Email: Required

Street 1:

Street 2:

City/State/ZIP:

City	State Required	ZIP Required

Yes, I would like to receive e-mail from Devereux

Email Format:

Question - Not Required - Your relationship to client:

Thank you for your referral. A member of the Central Referral Unit will contact you.