Online Counseling Request Form

Casa Youth Shelter is committed to your privacy and confidentiality. It is important to know that while we keep the information as secure as we can, electronic information is susceptible to breaches that would be out of our control. It is for this reason that we ask you to provide the information requested and all additional sensitive information can be obtained by the clinical partner at the time services begin.


During this time of global crisis Casa Youth Shelter is committed to providing essential services to the community. While we provide non-residential and extended aftercare counseling to our clients for a fee, we will be suspending all fees while the “Stay-at-Home” order is in place.