The provider referral form below is to be completed by providers in the community such as social workers, counselors, case managers, psychiatrists, nurses, medical doctors, schedulers, etc. Our scheduling team will be contacting your client on the same business day that the referral is received. We can get your client scheduled for a same day or next day counseling appointment. We can collaborate with you, as the referring provider, to inform you of the date, time, and location of your clients intake appointment.
We accept Aetna, Banner Aetna, BCBS, Optum/United Healthcare and Cigna.
We do not accept Medicare and Medicaid.
Open today | 09:00 am – 05:00 pm |
Feel free to download and use this release of information form.
Release of Information Form (pdf)
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