Connect with OhioRISE

Lighthouse Youth & Family Services is ready to answer your questions about OhioRISE. Get connected with our team today.

Lighthouse Youth & Family Services is ready to answer your questions about OhioRISE. Get connected with our team today.

Are you referring for yourself or on behalf of someone else?*
- Myself/My Child
- Someone Else
If you are submitting a referral on behalf of someone else, is their legal guardian aware the referral is being made?
- Yes
- No
- N/A
Contact Name*
First Last
Contact Email*
Contact Phone
Youth Name*
First Last
Youth Date of Birth*
Month
Day
Year
Youth's Legal Guardian Name*
First Last
Youth's Legal Guardian's Phone Number
Youth's Legal Guardian's Email*
Relationship of Legal Guardian to Youth
Your comments
Is youth being referred for a CANS assessment due to a Qualified Residential Treatment Program placement?
- Yes
- No
Is the youth being referred for a WAIVER CANS assessment through the OhioRISE Waiver program?
- Yes
- No
Please verify that you are human.

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