For public agencies, health care providers, and families:

Please use this form, at no charge, to submit a referral for the placement or services for a child or young adult.


The information is promptly sent to Ohio Children’s Alliance provider agencies and identifying information about the child (if present) is screened out. Please refrain from entering identifying information about the child.

The provider agencies will contact you directly.

Need more details? Contact us.

Ohio Children's Alliance

Ph: (614) 461-0014 

2600 Corporate Exchange Drive 

Suite 180  

Columbus, OH 43231

© 2020 Ohio Children's Alliance

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