ETT // Case File: The Referral

Mr. Ed’s Circle of Trust, Inc. presents

A Dr. RAD: The Attachment Code Breaker™ production

The Referral

They called it “bad behavior.” He called it a code.

How to make a referral for Specialized Therapeutic Services at Elevating Trauma to Trust: who can refer, what to bring, and what happens after you hit send.

Submit a referral Download the form (PDF)
Rated RR — Relational Repair Contains intense trust-building, unexpected bonding, and zero Band-Aid behavioral approaches. Caregivers strongly cautioned: your kid may start feeling safe.

Act I — Snapped

The cast

Anyone in a child’s corner can start the story. Parents, professionals, schools, courts. If you can see the code, you can send the referral.

  1. Starring Parents & legal caregiversBiological, adoptive, foster, and kinship
  2. Co-starring School personnel, ESE staff & educators
  3. With Case managers & Guardians ad LitemAnd child-welfare professionals
  4. And Attorneys, courts & forensic prosSeeking expert services
  5. Special appearance Licensed clinicians & agenciesRequesting consultation or specialized assessment
  6. Introducing Professionals booking groupsSNAP → SOLID Training or parenting classes

Act II — Shifted

The arsenal

Every service runs through the Attachment Code Breaker™ lens. When you refer, tell us which one you need. If you’re not sure, tell us what you’re seeing and we’ll help you pick.

Reel 01 · Specialty

Attachment Bonding & RAD Assessments

Specialized assessments of attachment patterns, bonding quality, and Reactive Attachment Disorder indicators, with placement and parenting recommendations.

Reel 02

Individual & Family Therapy

Reel 03

Group Therapy

Reel 04

TBOS

Therapeutic Behavioral On-Site Services, delivered where the child lives and learns.

Reel 05

In-Depth Assessment

Reel 06

CFARS

Ages 5–17

Reel 07

FARS

Ages 18+

Reel 08 · Courtroom

Expert Witness Testimony

Handled under a separate engagement agreement.

Reel 09 · Training

SNAP → SOLID Training

For schools, agencies, and teams.

Reel 10

Attachment-Focused Parenting Classes

Reel 11

Trauma-Focused Parenting Classes

Final reel

Not sure yet?

Pick “Help me choose” on the form.

Act III — Solid

The plot, in five scenes

The step-by-step referral process, from the first call to the first appointment.

  1. Step 1: Initial contact

    Int. Your phone — day

    Our hero (you) makes first contact. Call, text, or email. Nothing fancy.

    You

    (confident, slightly caffeinated)

    “I’d like to make a referral for specialized therapeutic services. Primary need: therapy, TBOS, an assessment, training, or expert witness.”

    Cut to:

  2. Step 2: Provide basic referral information

    No PHI by email

    Int. The briefing room — continuous

    You lay out the case file. Be ready to share:

    • Full name and date of birth of the child or client
    • Name and contact info of the legal guardian or referring party
    • Current living situation: home, foster, adoptive, kinship, or residential
    • A brief description of concerns: attachment difficulties, trauma history, behavior, school issues, court involvement
    • The specific service(s) requested
    • Insurance or funding info if known: Medicaid, private, self-pay, agency contract
    • Any court orders, safety plans, or time-sensitive deadlines

    (Don’t send protected health information over regular email. A secure channel is provided after first contact.)

  3. Step 3: Consent and authorization

    Int. The signing table — later

    A pen hovers. The music swells. Paperwork, but make it heroic.

    • A parent or legal guardian must give written consent before clinical services begin.
    • Professional referrals that involve protected information need the appropriate releases of information.
    • Expert witness and training referrals follow separate engagement agreements.

    Match cut to:

  4. Step 4: Intake review and scheduling

    Int. Code Breaker HQ, Lakeland, FL — night

    The team reviews the referral for clinical fit and availability. Then the phone rings. It’s for you.

    1–2business days, typical response for non-emergency referrals

    We’ll contact you to schedule an initial consultation, an assessment appointment, or a training date.

  5. Step 5: Next steps after acceptance

    Accepted

    Ext. The first day of solid — golden hour

    Referral accepted. You receive confirmation of the service, any required paperwork, and your appointment or training details.

    • TBOS or intensive services: we explain the extra eligibility criteria and treatment-planning steps.
    • Assessments (CFARS, FARS, specialized attachment): we lay out the assessment process and the reporting timeline.

    Fade to: trust.

Classified materials

The dossier

Prefer paper? Download the referral form, fill it out, and send it to Referrals@MrEdsCircleofTrust.com or fax it to (850) 270-6733.

Referral Form for Services

Attachment Bonding Assessment & related therapeutic services. Covers referring party, client info, clinical questions, background records, and funding authorization.

PDF · 2 pages · 742 KB Download ↓

How to Make a Referral

The full printable instructions: who may refer, the services available, the five steps, and important notes.

PDF · 2 pages · 7 KB Download ↓

Attachment Bonding Assessment fees

$1,250
Base fee: one child + 2 adults in the same household
$850
Each additional child, or a person from a different household
50%
Retainer before the assessment starts; balance due before the report is released

Funding authorization is required before the assessment begins.

Screening room

Preview not loading? Open the PDF in a new tab.

Take 1 Referring party
Pick the role that fits best.
Who’s making the referral?
Tell us who to reach.
Add a phone number we can call back.
That email doesn’t look right.
Best way to reach you
Take 2 Service(s) requested *
Pick at least one, or “Help me choose.”
Take 3 The client
Initials only. We collect full names securely later.
Primary concern (check any)
Skip diagnoses, records, and identifying details. Those come later through a secure channel.
Take 4 Funding & deadlines
Court date, report due date, or training date.
Paperwork on hand
Both boxes are required before we roll.
Sending this starts a referral. It doesn’t guarantee services until the case is reviewed and funding is authorized.

That’s a wrap.

Your referral is in. Here’s what happens next:

  1. The team reviews it for clinical fit and availability, typically within 1–2 business days.
  2. We reach out the way you asked and send a secure channel for any protected information.
  3. Consent and releases get signed, then we schedule the consultation, assessment, or training date.

Have the completed referral form ready? Email it to Referrals@MrEdsCircleofTrust.com or fax (850) 270-6733.

Read before you roll

The fine print

Emergencies go to 911

Safety crises should go to 911 or local emergency services. This practice is not an emergency crisis response service.

No PHI by regular email

Please don’t send protected health information through standard email. Secure channels are provided after first contact.

Training & expert referrals run differently

Training, parenting classes, and expert witness referrals focus on dates, audience, and engagement terms.

Repair over Band-Aids

All clinical work follows the Snapped → Shifted → Solid™ framework and puts relational repair ahead of Band-Aid behavioral approaches. Acceptance of a referral doesn’t guarantee services until funding authorization is received and the case is reviewed.