A small outdoor patio with stone tile flooring, two weathered wooden chairs, a small stone statue of a seated Buddha, and various green plants, including climbing ivy on a wooden fence and a pine tree on the left side.
Person filling out a form on a clipboard with a black pen, with a blue sticky note attached to the clipboard, on a white surface.

Therapist Referral

To refer a client for a medical evaluation and prescription, please complete the HIPAA-compliant form.

When you complete the form, please instruct your client to schedule an appointment as a new patient

HIPPAA Form