For Healthcare Providers

Intake / Referral Form

Email completed referrals to referrals@gahealthpartners.com or submit below.

Service(s) Requested

Non-Intensive Outpatient Services (Individual, Family, and Skills 1-3 sessions per week) (NIOP)Peer Support (Adults only)Psychiatric Evaluation and Treatment / Medication Management (must be in conjunction with NIOP, IFI, or Peer Support)Intensive Family Intervention (Individual, Family, and Skills at least 3 sessions per week) (IFI) (Child and Adolescent Only)

Preferred Therapist

Preferred Paraprofessional

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Intake / Referral Form

Referral Source Information

Service(s) Requested

Reason for Referral

SMS Disclosures