Serving Anoka, Hennepin, Ramsey, Washington, Scott, Dakota & Carver Counties
Referral Submissions
Refer a child for care at Elite Services Center Inc
Whether you’re a parent, pediatrician, school professional, or case manager, this form gets a child’s information directly to our clinical team so we can begin the intake process quickly and thoughtfully.
How Referrals Work
A clear starting point for every family
The details below help our clinical team understand a child’s current needs before we ever pick up the phone — so that first conversation is informed, not generic. Fields marked as specify-your-own give you room to add context our checkboxes can’t capture.
Once submitted, a member of our intake team reviews the referral, verifies insurance where applicable, and reaches out to schedule next steps — typically a CMDE evaluation if one isn’t already on file.
Referral Form
Please complete each section as fully as possible. Fields marked “please specify” give you space to add detail beyond the listed options.
This form is a design mockup and is not yet connected to a live submission system.
After You Submit
What happens next
Every referral is reviewed personally by our clinical intake team — not sorted automatically by a system.
01
Review
Our intake team reviews the referral details, including diagnosis, schedule needs, and insurance information.
02
Contact
We reach out by phone or email within one to two business days to introduce ourselves and ask any follow-up questions.
03
Verify
Where applicable, we verify insurance benefits so your family has a clear picture of coverage before anything is scheduled.
04
Schedule
We schedule your child’s CMDE evaluation, or move directly to building a treatment plan if a valid CMDE already exists.
Prefer to speak with someone directly first?
If you’d rather talk through a referral over the phone before submitting details in writing, our team is happy to help.