Recommendation for Clinical Counseling

Recommend a Child

Child's Name

First Name

Last Name

Name of Child's Caregiver

First Name

Last Name

Caregiver's Phone

(###)

###

####

Caregiver's Email

Child's Age

Child's Group Night (if already placed)

Reason for Recommendation

Recommending Staff Member's Name

First Name

Last Name

Recommend a Caregiver

Name of Caregiver

First Name

Last Name

Caregiver's Phone

(###)

###

####

Caregiver's Email

Caregiver's Group Night (if already placed)

Reason for Recommendation

Recommending Staff Member's Name

First Name

Last Name

OUR VISION IS THAT NO CHILD WILL GRIEVE ALONE.

The mission of Valerie’s House is to help children and families work through the loss of a loved one together and go on to live fulfilling lives.

Fort Myers Mailing Address:
PO Box 1955
Fort Myers, FL 33902

Naples Mailing Address:
819 Myrtle Terrace
Naples, Florida 34103

Punta Gorda Mailing Address:
233 East McKenzie Street
Punta Gorda, Florida 33950

Pensacola Mailing Address:
904 East Gadsden Street
Pensacola, Florida 32501

Valerie’s House has received the Guidestar Seal of Transparency.

VALERIE’S HOUSE, INC.
Fort Myers • Naples • Charlotte County • Pensacola
Phone 239-204-5804

Valerie’s House is a 501(c)3 charitable organization, registration # CH46827. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. For more information, contact the Florida Department of Agriculture and Consumer Affairs at 1-800-HELP-FLA (435-7352) or visit www.freshfromflorida.com.

Form - Clinical Counseling Recommendation

Recommendation for Clinical Counseling

Recommend a Child

Recommend a Caregiver

Valerie's House

Follow us on social media!

OUR VISION IS THAT NO CHILD WILL GRIEVE ALONE.

The mission of Valerie’s House is to help children and families work through the loss of a loved one together and go on to live fulfilling lives.

Fort Myers Mailing Address:
PO Box 1955
Fort Myers, FL 33902

Naples Mailing Address:
819 Myrtle Terrace
Naples, Florida 34103

Punta Gorda Mailing Address:
233 East McKenzie Street
Punta Gorda, Florida 33950

Pensacola Mailing Address:
904 East Gadsden Street
Pensacola, Florida 32501

Valerie’s House has received the Guidestar Seal of Transparency.

Form - Clinical Counseling Recommendation

Recommendation for Clinical Counseling

Recommend a Child

Recommend a Caregiver

Valerie's House

Follow us on social media!

OUR VISION IS THAT NO CHILD WILL GRIEVE ALONE.

The mission of Valerie’s House is to help children and families work through the loss of a loved one together and go on to live fulfilling lives.

Fort Myers Mailing Address:PO Box 1955Fort Myers, FL 33902

Naples Mailing Address:819 Myrtle TerraceNaples, Florida 34103

Punta Gorda Mailing Address:233 East McKenzie StreetPunta Gorda, Florida 33950

Pensacola Mailing Address:904 East Gadsden StreetPensacola, Florida 32501

Valerie’s House has received the Guidestar Seal of Transparency.

Fort Myers Mailing Address:
PO Box 1955
Fort Myers, FL 33902

Naples Mailing Address:
819 Myrtle Terrace
Naples, Florida 34103

Punta Gorda Mailing Address:
233 East McKenzie Street
Punta Gorda, Florida 33950

Pensacola Mailing Address:
904 East Gadsden Street
Pensacola, Florida 32501