Member Referral Form | Partners

Thank you for your interest in referring an individual to Edify Behavioral’s community-based mental health programs and services. This form is designed exclusively for institutions, including schools, healthcare facilities, social service agencies, and other community organizations. Your referral helps ensure that those in need receive the appropriate care and resources.

 

If you are a family member or friend looking to refer someone, please use the following link: 

Community Referral Form

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Please complete the form below with as much detail as possible to help us best serve the referred individual. Once submitted, our team will review the information and follow up within 24-48 hours.

 

If you have any questions or need assistance, please contact us. Thank you for your commitment to supporting mental health and well-being in our community.