School Referral Form

Altura Mental Health is dedicated to providing a seamless transition 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 the referred student 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.

For further information about our services and the intake process, please visit our website or contact our office directly at (619) 350-0077.

Referral Source Information

Parent/Guardian Contact Information

Parent/Guardian Awareness and Support

Reason for Referral