How to Submit a referral 

You may direct patients to our Free Consultation Form, where they can schedule a call at a time that works for them.

If patient consent has been obtained and the patient has agreed to be contacted, you can: 

Send the referral via email: Info@MindsInActionCounseling.com

Or use the referral form below.

In the fields, include:   

• Referring contact’s name
• Phone number
• Email

In the body of the message add:

• Clinic name and location
• Patient (or parent/guardian) contact information
• The insurance name, example: “Aetna”, “BCBS” etc.
• Requested service or presenting concern
• Any other pertinent information