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Child and Adolescent Day Mental Health Treatment Programs

Name: Youth Haven Services
Telephone: (336) 285-7079

- Day treatment serves youth, elementary through high school, who, for behavioral/emotional reasons, cannot safely and successfully attend a public-school setting.
  
  The Day Treatment programs are specialized learning environments in which clients receive treatment in smaller, more individualized classroom settings. The programs are housed in the public-school setting. We partner with the Rockingham and Stokes county school systems, as we provide clinical oversight and direction to the programs.
  
  This partnership ensures that each youth is able to earn school credits while acquiring strategies to successfully cope with their behavioral and emotional challenges.
- YHS Referral Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  REFERRAL SOURCE
  
  AGENCY NAME REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  PLEASE CHECK (BELOW) YOUR PREFERRED LOCATION REQUIRED Rockingham County Schools Stokes County Schools Asheboro City Schools Please fill out this field.
  
  Name of Person for Whom Services are Requested
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's Contact Information (email, phone, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Why are you seeking services? REQUIRED Please fill out this field.
  
  Primary Insurance REQUIRED Please fill out this field. Please enter valid data.
  
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