BGCN Intake Form

BGCN Intake Form

To make a referral please complete the form below. Referrals will then be screened by one of our mental health professionals. Referrals do not guarantee counseling services, additional intake paperwork is required before counseling sessions will begin.

If there is an emergency, dial 911

To report a case of abuse, call the Division for Children, Youth and Families at 603-271-6562

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