Attorney Referral

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Attorney Referral

Temperantia-KYH welcomes referrals from attorneys, probation officers, and court personnel. Please complete the form below to refer a client. Our administration will contact your client within 24–48 hours of receiving the referral.

You are also welcome to email referrals directly to [email protected] or call (845) 814-8311. Please copy us on any court orders at the time of referral.

Section 1 — Referring Attorney Information

Attorney Full Name

Firm / Organization

Email address

Phone Number

Section 2 — Client Information

Client Full Name

Client Phone Number

Case Number

Court / Jurisdiction

Court Order Details / Special Conditions

Court Order Attached?

Section 3 — Program Requested

Select All That Apply

Court-Ordered Anger ManagementProbationary Anger AdjustmentAnger Management for Aggressive Driving MitigationEmpowered Path: Domestic Violence InterventionWorkplace Compliance Anger ManagementCorporate Anger Management WorkshopFamily Restoration: Certified Parent Training Specialist - Coming Soon

Additional context, urgency, or scheduling needs

I confirm that I am an authorized referral source and that the information provided is accurate to the best of my knowledge. I understand that Temperantia-KYH will review this referral and contact the participant directly to arrange intake.