SHBH Outpatient Referral Form

You Are Beginning A Referral for Outpatient Therapy

To complete this referral form, you will need the patient's insurance information and contact information for all legal guardians. Please be aware that there are currently significant wait times for services, and you may be offered group services while you are waiting for individual or family therapy.

Please start this referral form when you have all information listed above on hand. You should expect it will take about seven minutes to complete this form in full.