Johari Family Services, LLC
"EMPOWERING FAMILIES, BUILDING STRONG COMMUNITIES"
Home
Services
Referral Form
Locations
Careers
Contact Us
Johari employees have been very sweet, understanding and very helpful. They have treated me and my family with the utmost respect. It has been a joy working with Johari.
In 2011, 95% of our clients improved negative behaviors and 60% remained in their homes with no further treatment necessary.
Empowering families, building strong communities.
Johari helps families stay together.
Johari is Commission on Accreditation of Rehabilitation Facilities (CARF) accredited!
Referral Form
Date of Referral:
Referral Type:
- - Select - -
DSS
DJJ
School
Primary Care Physician
Community MH agency
Self
Family or Friend
LME
Other
Referral Name:
Referral Email:
Referral Contact No:
Insurance Type:
- - Select - -
NC Health Choice
Medicaid
Insurance Policy No:
First Name:
Last Name:
Date of Birth:
Ethnicity:
- - Select - -
American Indian/Alaskan Native
Asian/Pacific Islander
Black
East Indian/Indian Subcontinent
Hispanic
White
Other
Gender:
- - Select - -
Female
Male
Other
Address Street 1:
Address Street 2:
City:
Zip Code:
Daytime Phone:
Evening Phone:
Requested Service(s):
- - Select - -
In-Home Family Therapy
Outpatient Therapy
Comprehensive Clinical Assessment
Multisystemic Therapy
Precipitating Event/Reason for Referral:
Primary Axis I Diagnosis:
Substance Abuse Concerns
Explain any safety concerns:
Comments:
Follow Us
Quick Contact
Name:
Email:
Message: