Referrals

Please complete the PERSONAL REFERRAL FORM if you are seeking counseling services for yourself or someone under your care.

If you are a healthcare provider or referring on their behalf, please complete the PROFESSIONAL REFERRAL FORM. 

We are dedicated to protecting our clients' privacy. Information submitted on this form is confidential, encrypted, and secure.

At this time, potential clients can expect a wait time of 3-6 months for services to begin. 

Clients and referring providers will be contacted by one of our care coordinators if additional information is required, and again when an appointment becomes available. If you have questions, please CLICK HERE to e-mail our Office Manager, Amy Stewart.