Denver County Court

CONFIDENTIAL – Forensic Peer Navigator Referral Form

Thank you for your referral to the FPN program! We sincerely hope to help!

To help discern whether a client referral to FPN may be appropriate, please review the considerations below before filling out the referral form.

Does the client:

  • Have a charge(s) that meet the legal criteria for eligibility in our program? Open Denver Municipal/County case: M, GS, T, R)?
  • Desire to connect with someone for peer support (emotional support around substance use/mental health and criminal justice involvement)?
  • Fully understand that working with an FPN is VOLUNTARY and NOT mandated or a condition of any program or its goals, probation, or orders from a Judicial Officer?
  • Has the client been connected to all resources available (while in custody, pretrial, probation, or by referral source) and need further support facilitating connections?

*If a client desires support while in custody, we are glad to provide that with:

  • An initial Securus connection
  • Then a follow‐up connection before the client is released.

FPN Referral Form

*Only Peer Support Specialists will see this information. Please fill out as much information as possible.

Date of Birth(Required)
Preferred Method of Contact
Example: Probation, Wellness Connectors, Specialty Court, Self
Next Court Date
Out of Custody

*Has client been connected with all needed resources available in/from custody? (AID Center, Second Chance Center, Release After Dark, in-custody programming, etc.)
Client requested support with:
*Client self-disclosed:
Rent, Own, Friend/Family
Potential Support Connections: Check if Applicable
Potential Support Connections: Check if Applicable