Refer a Family to Eden & Embrace

Thank you for the work you do. If you’d like to connect a family with steady, emotionally safe support, you can send a referral here. This form is designed to be quick, respectful, and easy.

Referral Form

Your Name & Role

Your Email

Parent/Client Name

Parent/Client Email (only if approved to share)

Parent/Client Phone (optional)

What are they looking for?

Timing

Notes (anything helpful for me to know)

I confirm I have permission to share any parent/client contact information included above. If I do not have permission, I will leave it blank and encourage the family to reach out directly.

Prefer email instead? Send a referral to YOUR_EMAIL_HERE .

Professional note: I value collaborative, respectful care and honor the scope and expertise of all providers involved. My goal is always to support families in a way that feels calm, informed, and emotionally safe.