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Rockford Barbell

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The Winnebago County Community Mental Health Board is a vital partner and resource for Rockford Barbell as a funded mental health service provider.

Want to refer someone to our programs? Fill out the form below.
Referrals must be from a service providor and must have consent to share information.

Parent/Guardian Information

MUST HAVE CONSENT TO SHARE CONTACT INFORMATION

Parent/Guardian First and Last Name

Parent/Guardian Relationship to Child

Parent/Guardian Email

Parent/Guardian Phone Number

I am referring a child who is 10-18 years old

Referral Source Information

Referral Source First and Last Name

Referral Source Agency/School

Referral Source Phone Number

Referral Source Email

I certify that consent was received to share contact information with Rockford Barbell

Choose an option

Thanks for submitting!

Thank you to our sponsors!

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Phone: 815-505-3286

Email: eganet@rockfordbarbell.com

Tax Exempt EIN: 84-3216190

Located at:

208 Kishwaukee St, Rockford, IL 61104

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