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MENTAL HEALTH REFERRAL SHEET USE THIS SHEET TO KEEP TRACK OF THE INFORMATION YOU NEED TO MAKE A REFERRAL FOR MENTAL HEALTH/THERAPY SERVICES. THIS WILL HELP YOU LINK YOUR CHILD TO THE RIGHT SERVICESStep
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How to fill out mental health referral sheet

01
Obtain a mental health referral sheet from your healthcare provider or mental health professional.
02
Fill out your personal information accurately including name, date of birth, address, and contact information.
03
Provide detailed information about your mental health concerns and symptoms in the designated section of the referral sheet.
04
Include any relevant medical history, current medications, and past treatments for mental health issues on the referral sheet.
05
Sign and date the referral sheet to acknowledge that the information provided is true and accurate.
06
Submit the completed mental health referral sheet to the appropriate healthcare provider or mental health professional as instructed.

Who needs mental health referral sheet?

01
Individuals who are experiencing mental health issues such as depression, anxiety, or other mental health disorders.
02
People who have been referred for mental health evaluation or treatment by their primary care provider, therapist, or psychiatrist.
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The mental health referral sheet is a document used to refer individuals to mental health services or providers for evaluation and treatment.
Healthcare providers or professionals, social workers, school counselors, or any individual concerned about someone's mental health may file a mental health referral sheet.
To fill out a mental health referral sheet, you need to provide the individual's personal information, reason for the referral, any relevant background information, and contact information for both the individual and the provider.
The purpose of the mental health referral sheet is to connect individuals in need of mental health services with appropriate providers or resources for evaluation and treatment.
The mental health referral sheet must include the individual's personal information, reason for the referral, any relevant background information, and contact information for both the individual and the provider.
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