This referral form is meant to be used by medical other mental health providers and other agencies, organizations and professionals seeking to initiate outpatient services for clients in their care
. If you are requesting to schedule a session for yourself do not complete this form
, click the tab at the website that says schedule your session. If you have consent from the consumer you may also schedule their appointment by selecting the schedule your session tab.
All information submitted on this referral form is completely confidential, secure and encrypted.