Guardianship Referral Form

Please complete this form to request information or follow-up related to guardianship or decision-making support. This form is only for initial contact. A staff member will review the information provided and follow up to learn more about your needs.

Submitting this form does not guarantee services or legal assistance. This form is not for emerrgencies. If there is an immediate safety concern, call 911, 988, or Orange County Crisis Call Center at 311 or 1-800-832-1200.

Person Making the Referral
Name Name First Last
Agency/organization, if applicable
Phone Phone - ### - ### ####
Email
Relationship to person being referred
Person Being Referred
Name Name First Last
Age (in whole years)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Reason for Referral

Reason for Referral Interested in guardianship information Help understanding guardianship process Person is turning 18 Caregiver/family planning concern Need help with decision-making options Other
Does the person being referred or their caregiver know about this referral?

Guardianship Referral Form

Guardianship Referral Form

Person Making the Referral

Person Being Referred