Refer to Brightline

Please complete the form below, using both your information and the contact information for the child and their family. Once we receive the referral, someone from our Engagement Specialist team will contact the child’s parent to let them know they were referred to us. During our conversation with them, our goal is to learn about their child, explain what Brightline is, and schedule an appointment. 

If you have questions or prefer to refer a child to Brightline over the phone, call (888) 255-1395.

Using Microsoft Edge? Complete the referral using this compatible form.