If you are interested in services for yourself or your child, please complete the form below (one form per person - so if you are referring 3 of your children for services, please complete the form 3 times). All data is encrypted and secured, and fully HIPAA compliant!
Orange/Osceola/Seminole > email@example.com - Email Shere
Everywhere Else > firstname.lastname@example.org - Email Chelse
Do I need a referral from my doctor?
No. No referrals from doctors are needed for behavioral health.
Is my information secured?
Absolutely. Our servers are encrypted and fully HIPAA compliant. Your personal information is not share with any 3rd party other than the insurance company.
If you are a physician and would like to refer a client for services, please use the form below. You can also download the referral form, complete it, and email it back to us, your choice (there's a link on the bottom on this page for a hardcopy referral form).
This is our promise to you: We will be touch base with within 48 business hours! That's a promise. Have you ever sent in a referral form to a counseling company, never to hear back from them, or waiting weeks for an answer? Not here.
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Counseling & Behavioral Health