By law, only individuals who are 18 years or older may fill out this referral form. To begin a referral,
please note that the following information is recommended:
The juvenile's full legal name, date of birth, address, phone number
Information on at least one parent/legal guardian of the juvenile (full name, address, phone number and
relationship to the juvenile)
If you do not have the recommended information or need assistance filling out the referral, please call
Juvenile Intake at (703) 246-2495 for assistance. Once you have submitted your referral, you will
receive an email confirmation and will be contacted by Juvenile Intake.
