Application for Sliding Scale Fee Services
The therapy referral form is for clients who are requesting individual, group, couples and/or family therapy services.
The Psychiatric Rehabilitation Program (PRP) referral form is for clients who are active in therapy and need additional support. The Medical Necessity Criteria Form is also required to be completed along with the PRP Referral Form. Both forms must be completed by a Licensed Therapist of Licensed Social Worker. *Please note: This program is only available for clients who have Medicaid.
The Psychiatry Referral Form is to be completed by a Licensed Therapist, Licensed Social Worker, or Primary Care Physician. Clients must be in ongoing therapy in order to receive psychiatric services.
Consent Documents may be filled out prior to arriving to the office in order to save time.