  
      ✓
      Confidential Referral Process
    
      ✓
      Licensed Clinical Team
    
      ✓
      Colorado Behavioral Health Provider
    
      ✓
      Most Major PPO Insurance Accepted

Provider Referral Form

Submit a referral request and our clinical team will review the information and follow up regarding next steps.

Provider First Name *

Provider Last Name *

Credentials / Role *

Practice / Organization Name *

Email Address *

Phone Number *

Preferred Contact Method

Email Phone Either

Client First Name *

Client Last Name *

Client Age Range *

Client City (Colorado) *

What Service May Be Appropriate? *

Reason For Referral *

Current Level of Care *

Any relevant information about the client's needs?

Does the client have insurance? *

Insurance Carrier *

Client Availability *

Thank You For Your Referral

Your referral has been submitted successfully. A member of the TRUE Counseling team will review the information and follow up regarding next steps.