1-888-BPC-WELL
Click here for information on BPC’s partnership with NYS OMH and Community Mental Health Promotion and Support

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.

 

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.