Referrals & Forms

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Behavioral Health Referral

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Behavioral Health Intake Packet

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Center-Based Services Intake Packet

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Family Support Calendar

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Family-Selected Private Respite Providers and the Adaptive Equipment Application

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Family Support Services Application

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Family Support Services Invoice

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HIPAA Reporting Form

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PDP Training Form

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Private Provider Application

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TeleHealth Platform Instructions

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Worthington Calendar

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Worthington Calendar

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Worthington

445 E. Dublin Granville Road
Worthington, OH 43085

614-844-3800

info@iamboundless.org

Newark

140 W. Church Street
Newark, OH 43055

740-334-4056

info@iamboundless.org

West Carrollton

700 Liberty Lane
West Carrollton, OH 45449

Office

937-247-2400

Secure Document Destruction

937-247-2426

Transportation

937-823-2434

info@iamboundless.org

Medina County

1065 Medina Road
Medina, OH 44256

330-596-1042

info@iamboundless.org