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Referral FormInstructions to complete the referral form: Please complete all blanks with as much information that is available. If this is a psychiatic emergency, please call our office from the numbers on the website or our crisis line at 1-800-239-4673. If a child is under age 14, we must have permission from a parent or legal guardian to see the child. Once the form is completed, you may fax it to our offices. |