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BYD REFERRAL FORM
Sending a referral to BYDLLC online is quick - safe and easy. Simply enter your client's information
on our website. An electronic referral will be sent directly to us which will expedite the case in a manner much faster than
traditional faxes or phone-ins. To get started, Begin by entering your information above and click submit.
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You must agree to the statement below before completing a referral form:
I
hereby certify that I am an employee of the agency I have selected and understand the sensitivity of the information that
I am about to submit to Bagley Youth Development Assessment and Counseling Services. I testify that the information
that I am about to provide is accurate to the best of my knowledge. I understand that falsifying sensitive information is
punishable by law. I also understand that my IP address will be logged for security purposes.
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