Referral Form

To refer a child or adolescent to any of our programs, please complete the BPCC Referral form.

Download and print the form, complete it, and return it to us one of these ways:

  • fax it to (205) 348-9368
  • mail it to
    Brewer-Porch Children’s Center
    Box 870156
    University of Alabama
    Tuscaloosa, AL 35487-0156

If you have any questions while completing the form, contact our main office at (205) 348-7236. The receptionist will direct you to the best person to answer your questions.