Call 855.774.8444
TTY phone number is 818.774.3194
Hours of operation are: 8:30AM–5:00PM Mon-Fri
How to Enroll and Refer

Brandman Center Enrollment Form

Items marked with an asterisk * are required.

Prospective Enrollee Contact Information
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Referrer's Information
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Additional Information  *
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Prospective Enrollee's Current Living Arrangements: *

Please list any medical conditions that the Prospective Enrollee has:*

What services does the Prospective Enrollee need? *

Please use this space to add notes you think would be helpful for us to understand the Prospective Enrollee's needs: *