Make a Referral

To make a referral, just fill in the fields below, and a Portage Path admissions specialist will call your client to obtain more information and schedule an intake appointment.

Referral Information

Professionals who make referrals to Portage Path Behavioral Health, such as physicians, counselors, social workers, law enforcement/legal professionals, and social service employees are able to use this feature to begin the process of making a referral to Portage Path Behavioral Health.

The only information we are able to provide you with about your patient’s client’s treatment at Portage Path is whether or not they showed up for their first (intake) appointment. You will receive a response in the mail with this information.

If you think you will require ANY additional information about your patient/client, please take a moment now to download a copy of our Release of Information form.

Also, please know that experience has shown us that frequently individuals do not follow through with the referral made by a professional like yourself. You can help make sure your client gets the help they need by reinforcing the importance of making and keeping their appointment, and by reminding them that you will know whether or not they made or kept the appointment.

If you would prefer to fill out this form on paper and fax it to us, please download the fillable & printable PDF version.