We are now accepting referrals !

We accept referrals from the following:

· Parents

· Caregivers/Legal Guardians

· Local Department of Social Services

· Juvenile Services

· School Systems

· Court Systems

· Physicians

· Hospitals

· Department of Corrections

· Developmental Disability Administration

· Residential Facilities

· Other Healthcare Facilities & Service Providers

Eligibility

To be eligible for our program, one must satisfy ALL of the following requirements:

Youth: 5-17 years of age
Adults: 18+ years of age
Obtain a referral from a treating licensed mental health professional
Have an Axis I diagnosis from a licensed mental health professional
Currently have ACTIVE Maryland State Medicaid

We are currently accepting consumers.

Complete referral form below

General Referral Form

Clinician Referral Form Youth

This form is the general public and non-clinician referrals.

General Referral Form

Clinician Referral Form Youth

This referral form is for licensed clinicians only.

Clinician Referral Form

Clinician Referral Form Adult

This referral form is for licensed clinicians only.

Clinician Referral Form

Therapist Collaboration Form

Clinician Referral Form Adult

This referral form is for licensed clinicians only.

Therapist Collaboration Form

We are now accepting referrals !

We accept referrals from the following:

Eligibility

Complete referral form below

General Referral Form

Clinician Referral Form Youth

Clinician Referral Form Youth

Clinician Referral Form Youth

Clinician Referral Form Youth

Clinician Referral Form Youth

Clinician Referral Form Adult

Clinician Referral Form Adult

Clinician Referral Form Adult

Therapist Collaboration Form

Clinician Referral Form Adult

Clinician Referral Form Adult

Download referral form below

Stay Updated