Refer a Client

Submit a referral for comprehensive outpatient mental health services. We accept referrals from healthcare providers, case workers, family members, and self-referrals.

Hospital room with a wheelchair in a quiet care setting

Referral Form

Please complete all required fields below. All information is kept confidential in accordance with HIPAA regulations.

Client & Referral Information

Fields marked with * are required

Referral Source

Your Name *

Organization/Title *

Phone Number *

Email Address *

Client Information

Client First Name *

Client Last Name *

Date of Birth *

Client/Guardian Phone *

Address *

City *

State *

ZIP Code *

Insurance Information

Insurance Provider *

Member ID *

Clinical Information

Primary Diagnosis (if known)

Current Medications

Reason for Referral *

Services Requested

HIPAA Privacy Notice This form does not collect or transmit personal health information electronically. For secure transmission of medical records and protected health information, please call our office at +1 (443) 698-2175.

Intake Process Overview

What to expect after submitting a referral

Referral Submission

Complete and submit the referral form below or call our office

Initial Review

Our team reviews the referral within 24-48 business hours

Insurance Verification

We verify coverage and benefits with the insurance provider

Intake Scheduling

We contact you to schedule the initial intake appointment

Clinical Assessment

Comprehensive psychosocial assessment conducted by licensed clinician

Treatment Planning

Individualized treatment plan developed based on assessment findings

Expected Timeline

Our team reviews all referrals within 24-48 business hours. Initial intake appointments are typically scheduled within 1-2 weeks of referral approval, depending on availability and insurance verification.

Required Documents

Please have the following documents ready to expedite the intake process

Referral form (available below)
Current insurance card copy
Current psychiatric evaluation (if available)
Current medication list
Previous treatment records (if applicable)

Note: Documents can be brought to your intake appointment. Please do not email protected health information.

Questions About the Referral Process?

Our team is available to answer questions and provide guidance on submitting a referral.

Call +1 (443) 698-2175