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Refer a Patient to T.H. & Associates

T.H. & Associates LLC welcomes referrals from hospitals, healthcare providers, social workers, community organizations, and individuals seeking mental health services.

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Whether you're referring someone for our Mental Health Intensive Outpatient Program (MH-IOP), individual or couples therapy, or medication management, we're here to help connect individuals with appropriate care.

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Please complete the referral form below, and our intake team will review your request and follow up regarding next steps.

Submit a Referral

Referral Information

Who is submitting this referral?

Which Service are you referring for?

Which service(s) are you requesting?

Patient Information

Patient Preferred Contact Method
Phone
Email
Text
Any Option
Is the patient 18 years or older?
Yes
No
Primary Insurance Provider
Current Level of Care
Referral Priority

This form is not monitored for emergencies. If the individual is experiencing an immediate safety emergency, call 911 or visit the nearest emergency department.

Additional Service Specific Information

Preferred Patient Appointment Format
Preferred Appointment Availability

Authorization & Submission

Has the patient Agreed to be contacted regarding this referral?

Referral Acknowledgement

I understand that submitting this form does not guarantee acceptance into services or establish a patient-provider relationship. T.H. & Associates LLC will review the referral and contact the appropriate party regarding next steps.

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