To make a referral, please print and complete the following forms:

CASE WORKERS:

1) Psychological Services Referral Form (to be completed by case worker and signed off by supervisor and area administrator)

2) Foster Care Intake Questionnaire

CAREGIVERS:

1) Foster Care Clinic Parent Questionnaire

Harborview Foster Care Clinic

Specialty clinic with integrated care for foster children and caregivers for comprehensive evaluations including medical and psychological evaluations. We serve foster children in the greater Seattle area and Washington State.

Make An Appointment:

Primary Care Clinic: (206) 744-3344

Consult Clinic: (206) 744-4737 Or the form below

Request a Foster Care Consult Clinic Appointment

Caregiver Information

Your Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Patient Information

Patient's Date of Birth

YYYY

Patient's Name

Additional Information

Please include any specific goals, scheduling requests, or other additional information so that we can best prepare for your visit.

RESOURCES

Parents / Caregivers

Medical Providers / Trainees

Case Workers / Other Providers

REFERRAL FORMS

Harborview Foster Care Clinic

Make An Appointment:

RESOURCES