Referral Information

Referral Process

Step 1: Send us a message using the Contact Us form below or call (606) 872-2977

Step 2: Include Name, DOB, Phone Number, Email Address, Insurance Information, & a Brief Summary

Step 3: A link will be sent to your email to set up a password and sign into the patient portal

Step 4: Complete and sign all of the intake forms and screening tools prior to your initial appointment

Step 5: A clinician will be in contact with you to schedule the evaluation.

Intake forms including HIPAA Privacy Practices, Therapy and/or Targeted Case Management Informed Consent, Telehealth Consent, Freedom of Choice and Authorization of Protected Health Information will need to be completed, signed, and returned before the initial session with your clinician. 

ClinicSource is a therapy practice management software and a HIPAA compliant platform allowing you to have access to your signed documentation at any time, schedule your next appointment, and complete requests from your clinician.