If you are with a doctor’s office or other healthcare agency and wish to refer a patient to us, please complete the form below and fax it to one of our offices. If the Release of Information section is signed, a member of our staff will contact you within 72 hours regarding the status of the referral. Please write legibly 😀
Feel free to download and print out either the Adult Intake Packet or the Youth Intake Packet and provide those to the prospective patient.
Thank you for referring to Fremont Counseling Service.