Thank you for making a referral. Please complete the form by clicking the link below. You will be able to upload the intake assessment directly into the form. All submissions are made via HIPAA compliant transmissions. Once the submission is received, the referral will be reviewed and we will contact you to schedule the initial evaluation. Please email: firstname.lastname@example.org with questions.
You can also support the individual referred (or their conservator) with signing the consent for treatment electronically by sharing the link below.