Please fill out the form below
- Enter your first and last name
- Enter your client’s email address to create an account
- Create a password – all passwords MUST be at least 6 characters and contain no special characters (i.e. [email protected]#$%&*)
Already created an account? Login below with your email and password to continue to complete the referral form
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DO NOT USE YOUR EMAIL TO SIGNUP ONLY USE YOUR CLIENT’S EMAIL ADDRESS
- Please fill out your client’s information in the form below to refer them for therapy. Someone from our outreach team will contact your client within one week to complete an intake process over the phone.
- There is no cost to the client for therapy, thanks to our funders and generous donors.
- We ask clients to commit to a minimum of 4 months (16 sessions) of therapy; clients can discuss this more with the therapist in the first session.
- Talk therapy is not always a good fit for some of our clients. If it’s determined that a different type of therapy would suit your client better, our outreach team will help connect them to other services that meet their needs.