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Our Referral Form

Client Information

Insurane Information

Services Needed

In-Home Community Based Services



















Is the client (Check all that apply)







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Goals for referral

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B.O.S.S. UNITED
ASSESSMENT OFFICE
8677 Hospital Drive Suite 103
Douglasville GA. 30134
phone icon 678.715.6301
fax icon 678.715.6306


Barry Frazier MDIV MA LPC

Chief Executive Officer

phone icon  404.713.7050

Richard Hamilton MA LPC

Chief Clinical Officer

phone icon  770.873.9400

Tiquicha Harris LCSW

Executive Director

phone icon  678.715.6301

Zandra Chandler

Office Manager

phone icon   678.715.6301