Referrals & Admissions

Online Referral Form

Please fill out the electronic form below to send a message to our Admissions & Referrals team. For a PDF version, please download this form.

If you have any further questions, please do not hesitate to contact Ricky Yates, Director of Admissions and Social Work at ryates@mycri.org or (703) 842-2312 for more information!

Referral Form

Admission Departments

Mental Health Services

Phone Number: 703.842.2312

Developmental Disability Services

Phone Number: 703.842.2312

Youth Services

Phone Number: 703.842.2312