Partial Hospitalization Program Referral

Admission into Community Country Day School’s Partial Hospitalization requires a referral from a mental health provider. If you are a parent looking for placement into our Partial Hospitalization Program, please review our requirements and then please contact your child’s mental health services provider for more information. You can also contact CCDS with questions at (814) 833-7933.

Partial Hospitalization Program Referral

Please complete the document in its entirety and provide enough information to support clinical criteria for admission to a partial hospitalization program.  You may also download a copy of this form and fax the completed document to (814) 835- 2250 for our review. 

Acceptance of your client is based on clinical and medical appropriateness.

CLIENT DEMOGRAPHICS - Step 1 of 4