Request Services

Use this page to request services by either selecting the Initial Referral Form or the Application for ABA Services Form below.

Select Your Preference:
Outpatient Mental Health/CBHI Services

Request for MH/CBHI Services

Client Contact Information

  • Enter information for client to be referred for services.

  • Date of Birth

 

Parent/Guardian Information

 

Name of Person Referring

 

Service Request Information

 

Client Environment Information

 

Insurance Information

 

Verification

Early Intervention (MA 0-3)

Request for EI Services
(MA 0-3)

Child Contact Information

    Enter information for child to be referred for services.

  • Date of Birth

 

Parent/Guardian Information

 

Name of Person Referring

 

Service Request Information

 

Child Environment Information

 

Insurance Information

 

Verification

Birth to Three Services (CT)

Request for Birth to Three Services
(CT)

CONTINUE

Autism Services (ABA Over 3 MA & CT)

Request for Autism Services
(ABA Over 3 – MA & CT)

Child Contact Information

    Enter information for child to be referred for services.

  • Date of Birth

 

Parent/Guardian Information

 

Name of Person Referring

 

Service Request Information

 

Child Environment Information

 

Insurance Information

 

Verification

To request services, please fill out the form on this page or call:
Intake/Admissions Dept: 508-427-5362

For employment inquiries, please fill out the form on our Careers page.

Below is the mailing address for South Bay Community Services’ administrative office, including Accounting, Billing, Payroll, Human Resources and Intake departments.

South Bay Community Services
1115 West Chestnut Street
Brockton, MA 02301

To file a formal complaint, please call our Compliance Hotline at 508-521-2850.

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CARF_SolidSeal

CARF Accreditation

Commission on Accreditation of Rehabilitation Facilities is one of the premier accreditation services in the mental health industry. Achieving accreditation requires a service provider to commit to quality improvement, focus on the unique needs of each person the provider serves, and monitor the results of services.


Proud Member of the Association for Behavioral Healthcare