Make a Referral

If you would like to make a referral, download and complete the referral form.  For assistance with downloading and filling out the form, please contact us at 800-877-6054.  Print, sign the form,* and fax it to the office location nearest you.

*Please remember, all referrals should be signed by a licensed mental health professional and include all relevant information regarding the individual’s emotional and behavioral functioning in daily life and the most recent mental health assessment and treatment plan.