Start a Referral

Referrals are welcome from families, individuals, schools, agencies, courts, hospitals, and community partners. We review every request to identify the right next step.

Referring a client as a professional or provider? Submit the referral below, you do not need to book a callback. A Foundations To Success team member will follow up directly with you and with the person being referred. If you simply have a general question, you can call 757-782-2181 or use our contact page.

What to Expect

Quick Review

We review referrals within 1 to 2 business days.

We’ll Call You

A team member will reach out to schedule intake.

Secure Intake

Clinical details are collected safely, not here.

Please share only basic contact and routing information here. Do not include diagnoses, detailed symptoms, trauma details, medication lists, Medicaid IDs, or social security numbers in this form. We'll collect any clinical information through our secure intake process after we connect.

Referral Form

Form not submitting? If the submit button does not respond, the page does not confirm your referral, or you do not reach a confirmation screen, your referral may not have gone through. Please call Foundations To Success at 757-782-2181 so our team can take the referral directly and confirm it was received.

You can also request a callback and we will follow up with you.

SMS / Text Message Consent (Optional)

If you provide a phone number and opt in on the form above, you agree to receive text messages from Foundations To Success related to your inquiry, referral, appointment reminders, care coordination updates, and follow-up support. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out. Reply HELP for help. Consent is not a condition of receiving services.

We do not sell or share SMS opt-in information with third parties for marketing purposes.

See our Privacy Policy and Terms & Conditions.

Not for emergencies, call 911 or text 988 in a crisis.
If this is a life-threatening emergency, call 911. If you or someone you know is in emotional crisis, call or text 988.

✦ Let's Connect ✦

Ready to Take the First Step?

Have questions before submitting? Our team is here to help you every step of the way.