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! *Our website is having a glitch, please email josh@southsideservices.org to learn more and request services. 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