How To Send a Referral To The Community Clinic:
1
Complete The Appropriate Referral Form
Referrals are only accepted by completing and submitting the Referral Form.
Note: If the information is incomplete or the incorrect form is used, the person who sent the referral will be contacted (if a contact number or email is on the form) to let them know they will need to send a complete and/or correct form. An email is required for communication.
2
Send The Referral Form To The Community Clinic By Email, Fax, Mail, Or In-Person
• Email or fax the form to the numbers on the bottom of the form.
• Mail or bring the form to The Community Clinic front office.
• Referrals are NOT accepted by phone or text.
3
Wait For Next Steps
The Community Clinic will review the Referral Form and contact the referred person by phone to collect additional information and provide information about next steps including program information, expectations, schedule and group availability, and payment options.
If the Community Clinic is unable to provide the additional services and/or mode of therapy that will best meet the needs of the individual/family, then an outside referral will be made. Additionally, if an individual/family needs more intensive services, such as substance use therapy, psychotropic medication management, then the therapist will refer the individual/family to an outside provider and assist in the referral process. The therapist is then responsible for obtaining authorization to speak with the other provider and coordinating services through ongoing communication with the provider(s).
Referral Forms
The Community Clinic provides an array for services for everyone, including those who are mandated to attend and complete a program as part.
We have two referral forms – one for mandated (Mandated Referral Form) and another for all other referrals (Non-Mandated and Self-Referral Form).
Definitions
• Mandated: Persons referred within or out of state that are required to participate in services as part of any open case related to legal or social services (e.g., Courts, DCF, PO, RMV)
• Non-mandated: Persons referred from any social service or community partner (e.g., hospitals, human service agencies, medical clinics, community partners) or self-referrals that enroll voluntarily
• Self-referral: Person(s) accessing services by their own decision and without a mandate
Please download and complete the appropriate referral form and follow the instructions below to send the referral to The Community Clinic:
Mandated Referral Form
Please complete this form for persons referred within or out of state that are required to successfully complete services as part of any open case related to legal or social services. (e.g., Courts, DCF, PO, RMV)
DOWNLOAD FORMNon-Mandated and Self-Referral Form
Please complete this form for persons referred from any social service or community partner (e.g., hospitals, human service agencies, medical clinics, community partners) or self-referrals that enroll voluntarily.
DOWNLOAD FORM