Referral Resource Guide Submission Form

Thank you for taking the time to help us update our referral resources.

We are collecting updated information from trusted referral partners so we can create a clearer, more approachable, and client-friendly referral guide. Our goal is to help clients better understand what each service offers, who it may be helpful for, and what to expect when reaching out.

Many clients feel overwhelmed, hesitant, or unsure when they are referred to a new provider, program, or higher level of care. Some may also experience emotional, logistical, financial, insurance-related, language, scheduling, or transportation barriers that make it harder to follow through with referrals. Having clear and accessible information can make the referral process feel less intimidating and help clients feel more supported in taking the next step.

Your responses may be used to help us better understand your services, support care coordination, and provide clients with accurate referral information when appropriate.

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Basic Information

Organization Name *

Website / URL *

Main Contact Email *

Phone

Locations

Service Format

• In-Person
• Virtual
• Hybrid

Services & Specialties

What services or levels of care do you provide?

(Examples: IOP, PHP, Residential Treatment, Group Therapy, Psychiatry, Medication Management, Substance Use Treatment, Trauma Treatment, Eating Disorder Treatment, etc.)

Brief Client-Facing Description

Please provide a brief introduction to your organization or program in 2-4 sentences. This description may be shared directly with clients and families as part of our referral guide, so it is helpful when the language feels warm, clear, and approachable. Ideally, the description should feel like it is speaking to a client or family member. The goal is to help them understand what you offer, who you support, and how your services may be helpful, without using overly clinical or technical language.

Who is typically a good fit for your services?

(What concerns, symptoms, or support needs do you commonly help with?)

What can clients expect when they first reach out?

(For example: consultation call, assessment, intake appointment, insurance verification, waitlist process, etc.)

What steps does your organization take to help clients feel supported and reduce barriers during the referral or intake process?

(For example: this may include follow-up calls, help with scheduling, insurance guidance, warm handoffs, care coordination, transportation resources, language support, or support for clients who feel hesitant or overwhelmed.)

Practical Information

Insurance Plans Accepted

Self-Pay Options

• Yes
• No
• Limited Services Only

What is the best way for clients or providers to make a referral?

(Phone, email, online form, direct contact person, etc.)

Is there anything else you would like clients to know before reaching out?

Please feel free to upload any kind of materials you would like to share with us

Drag & Drop Files, Choose Files to Upload

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