Provider Referral Form

The following form is for referring children to California Children's Services (CCS), a program offering services to children with special health care needs. For persons making a referral to CCS, please be complete. Without your information, we may not be able to contact a family. Please discuss the referral with the family.

You may return the CCS Referral/Request Form to CCS by FAX at (805) 681-4763 or by mail:

345 Camino Del Remedio
Santa Barbara, CA 93110

It is recommended that you call CCS at (805) 681-5360 to verify the receipt of this form.