Domestic & Community Anger Management Referral Form

Center for Child & Family Services

Our Trauma-Focused Domestic Violence and Anger Management Program supports individuals in recognizing unhealthy patterns while addressing the impact of trauma on thoughts, emotions, and behavior. Through structured, trauma-informed education and accountability, participants learn skills for emotional regulation, conflict resolution, and building safe, non-violent, healthy relationships.

757-838-1960 (Newport News)
757-229-7940 (Williamsburg)

Client Information

Date

First name

Last name

Address

City

State

ZIP

Client's Date of Birth - Month - Day - Year

Email address

Client's Phone number

Referring Agency

Name of Referring Staff

Phone # of Referring Staff

Out of Area - Telehealth Needed ?

Yes No

Program Referral

Please indicate which program you are referring the client to.

Domestic Anger Management Assessment – Violence Against Family Members, Spouses, Significant Others, etc. Assessment results determine 24/36-week group placement ($55/Assessment - $30/Each Group Session – Individual Sessions $55 Requires Approval - Case by Case) Community Anger Management Assessment –Violence Against Strangers/Non-Family including Road Rage, Workplace Anger, Bar Fights, etc. Assessment results determine 6/12-week group placement. ($55/Assessment - $30/Each Group Session - Individual Sessions $55 Requires Approval - Case by Case) Domestic Anger Management / Substance Abuse Assessment - 24/36-week group based on the assessment addressing BOTH domestic violence and substance abuse at the same time. ($70/Assessment, $40/ Each Group Session) Williamsburg Only

Is the Victim's Name and Telephone Number Available

Yes

Victim's Name

Victim's Phone Number

Additional information

Use the space below to briefly describe the referring incident or to provide any information you believe will be beneficial in properly assessing the client.

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Center for Child & Family Services

757-838-1960 (Newport News)
757-229-7940 (Williamsburg)

Our mission is to provide compassionate counseling and support services to foster resilience, promote healing, and empower individuals and families to lead stronger, more fulfilling lives. We are dedicated to helping people navigate life’s challenges by offering compassionate, evidence-based programs that foster informed decision-making, emotional health, financial stability, and strong family foundations. Our goal is to build healthier, more connected communities—one individual, one family at a time.