For Providers

For Providers

Please complete our patient referral form to get your paitents on the right track for recovery.

Patient Referral Form

Please complete this Patient Referral Form.  

If you need help now, call 911, head to an emergency room or call 1-800-273-8255

Are you suffering from any of these debilitating conditions?

  • Treatment resistant depression
  • Suicidal Ideations
  • Post-Traumatic Stress Disorder

Simply provide us your name and phone number and we will within 1 business day.

We will contact you

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