To be completed by a health provider.
In order to ensure a safe and supportive transfer of services for your client, we request referral sources complete the below External Referral Form for Outpatient Services. Our Intake Team will contact the client directly and inquire as to any accommodations they may need, inform them of fees, and schedule them with an appropriate clinician. Please submit the completed form via email to firstname.lastname@example.org or fax to 844-272-9333. If you would like to discuss your referral with our Intake Team, you may call them at 614-849-8204.
In order to make the most of your time during the first session, we encourage you to print and complete the paperwork below to bring to your first appointment. Please fill out as much as you can, and your therapist will work with you to address any questions or concerns you may have.
Please click the appropriate link below to download your paperwork.
If you are unable to bring your paperwork with you, please plan to come 15-25 minutes early for your first appointment and we will be happy to provide copies for you to fill out upon your arrival.