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Get Mental Health Referral
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How to fill out the Mental Health Referral online
This guide provides a clear and supportive process for completing the Mental Health Referral form online. By following these steps, you can ensure that all necessary information is accurately provided to facilitate appropriate care.
Follow the steps to efficiently complete the Mental Health Referral form.
- Press the ‘Get Form’ button to access the Mental Health Referral form and open it in your editing tool.
- Begin by filling out the general patient information section. Include details such as the patient’s name, date of birth, and contact numbers. If applicable, indicate if the patient is currently pregnant and provide the expected delivery date.
- Specify the marital status and living situation by checking all relevant boxes that apply to the patient.
- In the referral reason section, check all applicable options such as individual therapy or medication review. If necessary, attach the medication history.
- Complete the referral information section, including the referral source and date. Ensure that you indicate whether the patient is aware of the referral and their desire for treatment.
- If applicable, provide information regarding any current or previous involvement with a mental health clinician. List any treatments the patient has received or any current medications.
- Check all relevant services the patient has been involved with in the past six months and any clinical features that apply to their current condition.
- Finally, review the form for accuracy, and once satisfied, save your changes. You can also choose to download, print, or share the completed form as needed.
Complete your Mental Health Referral online today!
Call 1-800-273-TALK (8255) to reach a 24-hour crisis center, text MHA to 741741, call 911, or go to the nearest emergency room. Find a local MHA affiliate who can provide services. Find a therapist.