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send a referral

Professional Referrals

At AC+W, we know that mental health matters show up at every level of care. That is why it is important to us to provide a seamless referral solution for our community’s professionals to get their clients and patients the mental health care that they need.

If you prefer to fax your referral, please click the button to download the PDF Referral Form. Please feel free to reach out if there are any questions or concerns.

PDF Referral Form
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Help someone get the
care they need

Once the referring provider submits this referral form, we will make 5 attempts to reach the client. The first attempt will be made within 24 hours of form submission, and the remaining attempts will be made within 10 business days. We will notify you when the client has been successfully scheduled or if all 5 attempts have been made without being able to reach the client.