Referrals Columbus Behavioral Health

Referring providers

We are currently accepting new patients and welcome referrals!
We try to get all new patients scheduled within 1 week of the initial call.

Upon receipt of the referral form either faxed or submitted online, we will contact the patient to schedule an intake appointment.
If the patient does not respond or for other reasons does not schedule with us, we will notify you that we were unable to schedule an appointment.

Choose one of three convenient ways to refer a patient:
1. You or the patient can register and schedule directly online. You can fax additional information to us for the appointment.
OR
2. Fill out the form below
OR
3. Print and complete the provider referral form and fax it to us at 844-320-2600

If you need to connect with one of our staff for a provider consultation prior to the patient's appointment or in the process of a referral, please use the contact form on the bottom of the provider's bio page.

Referring Providers Form

* Indicates required field

Date of Referral *

Referring Physician/Practice *

Referring provider contact *

Referring Provider Contact No. *

Patient Name *

First

Last

Patient DOB *

Patient Phone No. *

Patient Email *

Patient Address *

Line 1

Line 2

City

State

Zip Code

Country

Insurance Name *

Insurance ID No. *

Please schedule with *

Counselor/Social Worker/Pyschologist for Counseling Psychiatric Nurse Practitioner (CNP) for Medications Both a therapist and CNP

Reason for Referral/Diagnosis *

Submit