Referrals For Physicians

Referrals

* Indicates required field

You can make a referral to Peninsula Behavioral Health in two ways:

1) If you are making an in-office referral, you and your patient can complete the form below. (Please note that this is not a secure means of communication).

If you would like us to follow-up with your office please be sure to fill in your contact information. After obtaining the appropriate release from your patient we will be in touch.

Thank you for your referrals. We look forward to working with you.

Referral FAQs

Can you provide medication or do medication management?
What will happen if you determine my referral is not a good fit?
What insurance panels are you contracted with?

Referring Physican *

Physician preferred contact information *

Reason for referral *

Patient Name *

Patient preferred contact information *

Best time to reach patient *

Submit