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Referral Form
This form is designed for health care providers, clergy, school personnel, and community members to refer someone for services. Please complete this confidential form as much as you can. We will follow up with you and the referral within two business days. Thank you!
Relationship to referred client:
Does the client plan on using insurance?
Which insurance company does the client have? (Please note: We only accept plans for the insurance companies listed below.)


Please check ALL of the providers that you would fit your patient's needs. You can learn more about all providers by clicking the links below:








Shaterra Walker, Licensed Professional Counselor

Hannah Einstein, Licensed Professional Counselor

Tameesha Curry, Resident in Counseling 

Chandra Shorter, Licensed Professional Counselor

Nijeria Jones, Licensed Professional Counselor

Lauren Rutledge, Resident in Counseling

Pragya Agarwal, Counseling Intern

Katelyn Lloyd, Counseling Intern

Julie Jackson, Counseling Intern

Corrinne Anderson, Counseling Intern

Tiffany Watlington, Counseling Intern

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Thank you for referring a client for our services. We have a high volume of requests and strive to respond to all requests for services within 2 business day. Thank you!

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