Submit A Referral
We value collaborative relationships with medical, psychiatric, and allied health providers. Any additional clinical information can be faxed with a ROI to (855) 702-2101. This form is secure and HIPAA compliant. Our admin team will contact the patient within 24 hours.
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.
