Make a Referral

Start with the right support.

Choose a service below to complete its referral form in Google Forms.

Adult crisis services

Residential Crisis Stabilization

Submit a referral for short-term, 24-hour residential crisis assessment and stabilization.

Open Crisis Referral Form

Questions? Call 804-240-4499.

Community Living Waiver

ID/DD Group Home Residential

Submit a referral for person-centered group home residential support.

Open ID/DD Referral Form

Safe Space Residential accepts the Virginia Community Living (CL) Waiver for Group Home Residential Services. Medicaid insurance coverage alone does not establish eligibility for this service.

Admission is subject to eligibility, clinical assessment, availability, and any required service authorization.

The referral forms open directly in Google Forms. This website does not collect or store your referral answers.