Request Services Request Services Do you or someone you know want to become a part of Southside Services? Fill out the form below and someone from our team will be in contact with you! Please enable JavaScript in your browser to complete this form.Client Name *FirstLastClient Date of Birth (mm/dd/yyyy) *Client Email *Client Phone Number *Who is the referring individual? *Case ManagerSocial WorkerParent/GuardianSelfParent/Guardian Name *FirstLastParent/Guardian Phone Number *What is something you like and admire about this individual? *Please briefly explain main concerns/ reason for referral: *What program are you requesting services for? *Community ConnectionsSchool Based ConnectionsTherapeutic RecreationSubmit