Make a Referral
Outpatient Clinic Registration Forms
Referral Forms for our Other Programs:
- Psychiatric Rehabilitation and Vocational Referral
- Assertive Community Treatment Referral
- Crisis Services Referral
- Residential Rehabilitation Referral
Need help choosing the correct form? Send us a message through our chat.
Accepted Insurance Policies
Please review our list of accepted insurance policies.
We also offer a Sliding Fee Scale. Click to complete the Outpatient Services Worksheet or Assertive Community Treatment Worksheet for those who cannot afford care. No one is denied access to care due to inability to pay. The sliding fee scale is based on family size and income level. Proof of income is required. One month’s income statements or tax filing information is acceptable.