A large room filled with students working at desks with laptops, some with headphones, in a modern, well-lit space with black ceiling panels and large windows.

Request Services

This is the referral form for services with Village Behavioral Health, also known as A Village Youth and Family Services. Please be as descriptive as possible when explaining the need for service.

A teal-colored digital flyer with the text '2025 Village Referral Form' and a black-and-white QR code in the center.

Insurances we accept

Aetna logo with a purple heart icon and the word 'aetna' in purple lowercase letters.
Sentara logo featuring a stylized yellow 'S' symbol and the word 'Sentara' in black text.
Molina Healthcare logo with three stylized blue figures and the company name.
Anthem logo with blue text and three blue symbols for healthcare, pharmacy, and insurance.
Medicaid logo with blue caduceus symbol