Submit A Referral
We value collaborative relationships with medical, psychiatric, and allied health providers. In the narrative portion of the form, please include your contact information, the patient’s insurance info, and any relevant clinical info. Any additional clinical information can be faxed with a ROI to (844) 770-0399.
By completing this form, you confirm that the client has provided explicit consent, is aware of the referral, and to the best of your knowledge, is appropriate for outpatient care. Submitting this referral allows our office to contact your client for an initial phone screen, and is not a guarantee of services.