Referral Of Services

BUILDING HOPE & RESILIENCE TOGETHER

Referrals are preferred to ensure proper triage of scheduling patients and are accepted from clinicians, primary care providers, case managers, clinics, and hospitals.

Documents to include with all referrals:

  • Most recent chart note and other pertinent documentation

  • A Release of Information

  • Patient Demographic Information

  • Referral Source, including Name, Program/Agency, Email Address, and Phone Number

  • Copy of front and back of insurance card so that benefits can be verified prior to appointment being scheduled.

Please fax required documents listed above to the confidential fax line:

(434)500-6182