Compass Referral Form

COMPASS Program Referral

If you are in crisis, call or text 988 to get connected with a trained professional. Oklahoma's Mental Health Lifeline: 988

Step 1 of 2

Referral Source(Required)

Youth Name(Required)

First Last

Grade Level(Required)

School(Required)

Gender(Required)

Date of Birth(Required)

Medicaid Number

Parent/Guardian Name(Required)

First Last

Phone(Required)

Alt. Phone(Required)

If no phone number, other means to contact: