Make a referral to Bleuler Psychotherapy Center using our HIPAA compliant forms
Behavioral Health Self-Referral Form
This form is intended for individuals who wish to refer themselves or someone else to Bleuler Psychotherapy Center. It can be used by family members, friends, or anyone who knows the person seeking help.
Behavioral Health Provider/Professional Referral Form
This form is intended for use by medical providers and personnel at Community Based Organizations as well as Criminal Justice Agencies referring an individual to Bleuler Psychotherapy Center. It ensures a seamless transition of care and facilitates communication between providers.
