Desert Mountain Children's Center

“Our Mission: The relentless pursuit of whatever works in the life of a child.”

Instructions on How to Complete and Submit the Online Referral Form

1. Fill in the Required Information: Complete all necessary fields in the referral form. Ensure that you provide accurate and up-to-date information to avoid any delays or errors in processing the referral. Make sure the email address for the referring party is correct (page 1) and the email address on the signature page is correct. 
2. Save Your Progress: If you need to save your progress and return to complete the form later, ensure you go to Options on the top left corner under CAHELP and click Save progress. You will be prompted to enter your name and email address. This feature allows you to save your work and resume from where you left off when you revisit the form that will be emailed to you.
3. Review and Sign: Before submitting the form, carefully review all the information provided to ensure its accuracy. Sign the form electronically using the provided signature field.
4. Submit the Form: Once you have filled out all the required fields, and provided your electronic signature, and verified the email address is correct, click on the “Click to Sign” button at the bottom of the form.
5. Confirming Email Address: To ensure accuracy and validity, an email will be sent to the referring party’s email address before the referral form can be completed. You must click on the "Confirm my email address" link provided in the email. The confirmation request will come from Adobe Acrobat Sign. Once you confirm your email address, you will be able to complete and submit the referral form.
6. Confirmation Receipt: After successfully confirming your signature, you will receive an email from CAHELP via Adobe Acrobat Sign. This email will contain a completed (PDF copy) and printable version of the referral form for your records. If you choose to open the agreement via the link provided, it will take you to a web page of the completed referral. (NOTE: You will have to download the PDF if you choose this function.) There is no need to forward a copy of the confirmation to the DMCC. This copy is for your records.
7. Printing the Form: Please note that you will not be able to print a copy of the form while completing the document online. However, you can print the completed form from the PDF attached to the confirmation email sent to you.

If you are experiencing any issues, please contact our office at (760) 955-3601 or by e-mail at [email protected].

Instructions on How to Submit a Printed Referral Form

1. Complete Required Information: Complete all necessary fields in the referral form. Ensure that you provide accurate and up-to-date information to avoid any delays or errors in processing the referral.
2. Signature Procedure: If the parent or guardian is available to sign the form in person, provide them with the form and have them sign and date it accordingly. If the parent or guardian is not available to sign in person, ensure that verbal consent is obtained and documented. In such cases, the referring party or another authorized person should sign and date the form, indicating that verbal consent has been given by the parent or guardian.
3. Submit the Referral: Once all necessary information has been provided and the appropriate signature obtained, submit the referral form to [email protected] or fax referral to (760) 955-3601.