Inquiries for Services

Getting Started

For inquiries and questions about the intake process for anyone over the age of 3, call the Intake line at (510) 618-6122 or complete the form below.

An RCEB Intake Coordinator will be in touch with you to collect additional information as needed.

Applicant's First Name

Applicant's Last Name

Applicant's Date of Birth

Applicant's Place of Birth

Legal Guardian/Caregiver First Name

Legal Guardian/Caregiver Last Name

Legal Guardian/Caregiver Address

Legal Guardian/Caregiver First Name

Legal Guardian/Caregiver Last Name

Legal Guardian/Caregiver Address

Applicant's Address

Best Contact Number

What is the best time to reach you?

Email Address

Reason for Referral