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referralS
Anyone may refer families to us with extra healthcare needs so long as the family members or individuals know that they are being referred and want the referral.
We offer individual and group support, referrals and information on healthcare eligibility and resources, including legal information, for families of children and youth with extra healthcare service needs on the Navajo Nation.
Note that HIPAA requires that you first check with the person you are referring and are reasonably sure that they want us to reach out to them. No written release is necessary.
You may use your own referral form and fax it to us at 888-263-2051, or email it to info@navajofamilies.org. If you use the form below, make sure you see a confirmation message on the screen which appears when your referral is successfully sent. Any questions, please call Josey at (505) 716-3030.
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Indicates required field
Please describe yourself
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I am a family member of the person I am referring
I am a friend of the person I am referring
I am a service provider
Other
If service provider/other, please specify
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My phone number is
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My email is
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What support services may we provide you?
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Connection with families, including clan families
Trainings and presentations
Navigating state and tribal health-related resources
Legal info on Navajo Nation processes and forms
Communication with families and providers
More than one option above
Please add any further comment
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Name of person referred
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Phone number and/or Email of person referred
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Navajo Nation Chapter of person referred {if known}
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Mailing address of person referred (helpful but not required)
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City
State
Zip Code
Country
Submit