230 North Limestone, Suite 100 Lexington, Kentucky 40507
(859) 303-8041 office@heatherriskandassociates.com

Referral Form for a Child / Adolescent

If you would like to refer a child or adolescent for an assessment or treatment, please complete the information below. This information will help Heather Risk PsyD & Associates, PLLC in ensuring your child's needs are met. After receiving the following information, we will contact you to discuss any questions and take the next steps to beginning services.

Caregiver(s) / Legal Guardianship Contact Information

Please include complete accurate information - You may place an asterisk (*) next to preferred methods of contact.