
PHYSICIAN REFERRAL FORM
We Are Here.
If you are a healthcare provider wanting the best in cognitive and behavioral therapy for your patients, download our referral form and fax it to us today.
Once we receive this information, we will contact your patient and schedule an appointment.
We take the following insurances, as well as self-pay: Aetna, Medicaid, Select Health by First Choice, Molina, Healthy Blue, Humana Medicaid, Cenpatico by Absolute Total Care, and First Choice VIP Plus.
Feel free to contact us with any questions:
(843) 501-7001