New Client Referral Form For Therapists

Therapists: Please save and complete the form. Email the returned form to admin@inspiringmindsinc.org to send referrals.\

Adult Qualifications:

  • Must be currently experiencing an approved mental health disorder or developmental disability (ex. Depression, Bipolar Disorder, Schizophrenia, PTSD, Autism, Intellectual Disability etc.)
  • Must receive Medical Assistance
  • Must be willing to commit to 6 visits with a PRP Counselor monthly
  • Must be willing to go to therapy¬†at least once monthly

Child Qualifications:

  • Must be currently experiencing an approved mental health disorder or developmental disability (ex. ODD, Anxiety Disorder, ADHD, Depression, Bipolar Disorder, Autism, Intellectual Disability, etc.)
  • Must receive Medical Assistance
  • Must be willing to commit to 3 visits with a PRP Counselor monthly
  • Must be willing to go to therapy¬†at least once monthly