To make a referral please fill out the form below and fax or email to the following:

Fax to: 860-799-4156

Email to: [email protected]

To download referral form Click Below: (if it does not download right click and open in new window)

Referral Form

Intake Forms to be Filled Out

Release of Information

Consent for Telehealth Services

HIPPA/Consent to Treat & Bill

Patient Information Form

Child Detailed Intake Form

Adolescent Detailed Intake Form

Adult Detailed Intake Form

Request More Information

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