Make a Referral | Earthora Orchard Living Services

Make a Referral

If you are a case manager, DSS worker, or licensed child-placing professional seeking a licensed, family-style placement for a child, we welcome your referral. Please complete the form below and our team will follow up within one business day. For urgent referrals, please call us directly at (571) 477-6137.

Two professionals discussing a case over a laptop

Who We Accept

We accept referrals for children and adolescents ages 0–17 with a developmental disability who cannot currently remain in their own family home. This includes intellectual disabilities, autism spectrum disorder, cerebral palsy, and related conditions.

How Payment Works

We accept the following to cover the cost of care for a child placed in our program:

Private Pay
Medicaid, through Virginia’s Developmental Disability (DD) Waiver

If you have questions about funding for a specific child, please contact us directly and we’re happy to help you sort out the details.

Referral Form

Your Full Name * Please fill this out.

Organization / Agency * Please fill this out.

Email * Please enter a valid email address.

Phone Number * Please enter a valid phone number.

Title / Role (optional)

Child’s First Name * Please fill this out.

Child’s Age * Please fill this out.

Child’s Gender (optional)

Main Diagnosis / Need * Please fill this out.

Where is the child currently living? * Please fill this out.

How urgent is this referral? * Please fill this out.

Additional Notes (optional)

Thank you for your referral.

A member of our placement team will follow up within one business day.