Facility and Physician Referrals

We accept referrals from primary care physicians, specialists, and other mental health professionals, from nursing homes, rehab settings, and continuum of care communities. The forms below can be filled out using Adobe Reader on your computer, printed out, and faxed to our office at 513-522-4577. Alternatively you can print them and complete them by hand.

How to Refer
This document tells you how to refer residents of senior care facilities.

Facility Referral Form
Complete this document and fax to 513-522-4577

Physician Referral Form

Consent Form
Please have the resident or resident's power of attorney for healthcare sign this consent form.

How Medicare pays for mental health services
This document explains how Medicare pays for psychological services. This document should be given to the resident or the resident's power of attorney for healthcare.