Clinicians

Clinician Referral Form

Clinician Referral: Seamless Transition to Outpatient Mental Health Care

Altura Mental Health is dedicated to providing a seamless transition for your patients from acute psychiatric care to our comprehensive outpatient programs. Our evidence-based, compassionate approach has helped countless individuals achieve lasting mental wellness.

By submitting this referral form, you acknowledge and agree that the completion and submission of this form does not establish a provider-patient relationship between you and any clinician at Altura Mental Health. This form is intended solely for the purpose of facilitating the referral process. Any information provided will be reviewed by Altura Mental Health staff to determine eligibility for services. Formal evaluation and treatment will only commence upon completion of all required intake procedures and mutual agreement to engage in a therapeutic relationship.

I am a:(Required)

Interested in(Required)

Clinician's Information

Clinician's Name(Required)

Email(Required)

Phone(Required)

Patient's Information

Patient's Name(Required)

Date of Birth

Patient's Phone(Required)

Patient's Email

Comments / Other Information

Once you submit the form, our dedicated intake team will promptly review the referral and contact you to discuss next steps. We prioritize collaboration with referring clinicians to ensure a smooth and successful transition for your patients. Together, we can empower your patients to achieve lasting mental wellness.