• Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Child’s most current diagnosis
  • History of most recent treatment services
  • Does the child demonstrate escalating problems of self-harm or assaultive behaviors as evidenced by
  • Please send all questions and referral information to:
    Admissions@sequelyouthservices.com or call: 712-310-9395

    A clinical decision cannot be made until collateral documentation is received. Collateral information can include, but is not limited to:
    - Predisposition reports including a list of current and previous charges
    - Current and past placement progress and discharge reports
    - Recent psychological evaluations including diagnosis and full-scale IQ score
    All information is handled securely and is not available to any third parties.