This form is to be completed by community providers- social workers, counselors, case managers, psychiatrists, nurses, liaisons, etc.- in order to help streamline the client referral and scheduling process. We contact clients on the same business day and we can get your clients scheduled for same or next day intake appointments. 

We accept Aetna, Banner Aetna, BCBS, Optum/United Healthcare and Cigna. We do not accept Medicare and Medicaid.

Clients you refer on this form must be aware and agree to you releasing their information directly to Healing Life Counseling.