Expressive Arts Place
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Counseling
​Referrals

    Provider Referral Form

    PROVIDER INFORMATION
    CLIENT INFORMATION
    Check all that apply.
    CLIENT (OR GUARDIAN) CONTACT
    Please complete a separate form for each person if you are making more than one referral UNLESS the individuals are a part of the same family unit or couple.
Submit
If the client (or guardian) is unaware you are making a referral on their behalf, instead of submitting a referral, please direct them to fill out our client counseling interest form at https://www.expressiveartsplace.org/counseling.html​ to ensure that they are okay with us contacting them regarding services.

Make room for the arts!


Hours

Mon- Sat: 10- 8pm

Telephone

617-294-6493

Email

info@​expressiveartsplace.org
  • Home
  • About Us
    • Our Mission
    • Our History
    • Our Guiding Principles
    • Our Team >
      • Our Founder
  • Services
    • Counseling
    • Support Groups
  • Join Us
    • Employment
    • Internships >
      • Internship Opportunities
      • Internship Program
    • Volunteer
  • Support Us
    • Contact Us