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 - PRP Referral Form Youth

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

General Referral Form

Clinician - PRP Referral Form Youth

This referral form is for licensed clinicians only.

Clinician Referral Form

Clinician - PRP Referral Form Adult

This referral form is for licensed clinicians only.

Clinician Referral Form

Therapist Collaboration Form

Clinician - PRP 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 - PRP Referral Form Youth

Clinician - PRP Referral Form Youth

Clinician - PRP Referral Form Youth

Clinician - PRP Referral Form Youth

Clinician - PRP Referral Form Youth

Clinician - PRP Referral Form Adult

Clinician - PRP Referral Form Adult

Clinician - PRP Referral Form Adult

Therapist Collaboration Form

Clinician - PRP Referral Form Adult

Clinician - PRP Referral Form Adult

Download referral form below

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