CPS ADVANCE Referral Form

THIS FORM IS INTENDED FOR CHILD PROTECTIVE SERVICES USE ONLY. 
If you need help, set up an intake appointment to speak with an advocate by calling our Outreach Office at 940-387-5131. If this is a crisis and you need to speak with someone right away, call our 24-Hour Crisis Line at 940-382-7273 or 800-572-4031.

Although clients with open CPS cases may seek DCFOF services on their own, this form must be received prior to an appointment for referred clients to receive services.


Please fill the form out in its entirety. If there is a question that does not apply to this client, write N/A. 

Referral Information






Please note, when providing DCFOF with a "safe number" that means that you have spoken with this client, verified that it is a safe number, verified that it is safe to leave a voicemail, and verified that it is safe for a DCFOF employee to identify.










Client Case
Victimization History







If you have NOT checked any of the above boxes this client is NOT appropriate for services, including the ADVANCE program.
Immediate Safety



If you are concerned this client is not safe, please call the DCFOF Crisis Line at 940-382-7273 or notify Sarah Lehman at 940-387-5131 x258 or Slehman@dcfof.org IMMEDIATELY, and DO NOT rely on this referral as a means to create immediate safety for your client.










Protective Order






Other Victimization History

About BIPP:
Regardless of their current relationship with the referred parent, their relationship with the children, their geographic location, etc. the fact that someone has used violence against a current or former partner makes them a risk to the referred parent, the referred parent’s children, and others in the community. When these people who have used violence are not referred to a BIPP program, the danger they pose to others has not been properly addressed. There are limited situations where it would be appropriate to not immediately refer someone to BIPP, such as, the person using violence first needs to address a substance abuse issue, they are incarcerated and their prison doesn’t offer BIPP, they have been deported to a country where BIPP is not available, or referral to BIPP would cause a dangerous escalation of violence.

Learn more HERE.







Please not that Child Safety Plans, Domestic Violence Safety Plans, Parental Child Safety Placement tools, and/or Removal Affidavits ARE REQUIRED to be sent with this referral form. DCFOF Cannot accurately assess the client's current situation, active safety threats, and The Department's concerns, without having these documents and being as informed as possible of the totality of the client's circumstances.

BY SUBMITTING THIS FORM YOU ARE CERTIFYING THAT YOU HAVE ATTACHED ALL REQUESTED AND PERTINENT PAPERWORK PERTAINING TO THIS CLIENT AS REQUESTED BY DCFOF  IN ORDER FOR YOUR CLIENT TO RECEIVE SERVICES.
Thank you! If you have any questions about this referral, please email Sarah Lehman at slehman@dcfof.org.