(919) 929-9610
We are growing! Looking for outstanding MDs, PAs, PMHNPs, and Therapists.CALL 919-354-0840 EXT 140 OR CLICK HERE TO LEARN MORE.

Referral Form

This form is intended only for clinical referrals. If you would like to submit a self-referral or are requesting an appointment on behalf of a family member or friend, please CLICK HERE.

If you would prefer to speak with our intake staff and schedule a referral for any of our locations, please call 919-929-9610

Referral Form

Please note:

  • We accept most forms of insurance, including Medicare. At this time, we cannot accept Medicaid as a primary or secondary insurance.
  • At this time we are not accepting patients who have been hospitalized more than twice in the past calendar year.
  • We do not offer detox services and cannot wean patients off of medications.
  • Please make sure contact numbers are up to date and patients are aware we will be calling.

Patient Demographics


Reason for Referral

Insurance Information

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