Get Started

Convenience is important to us (and to you!), and so we put together two options to get started right away.

In case of a medical emergency, psychiatric crisis, or if you are at risk of harming yourself or others, CALL 911 or seek the nearest emergency room. DO NOT use this form.

To Schedule Your Intake Appointment Use Our Online Scheduler

Online Scheduling

Once scheduled, you will receive a confirmation email with consent forms, please complete before your intake appointment. Prior to your appointment you will receive an email from [email protected] with a zoom link and instructions on how to attend your intake appointment.

To Submit an Agency Referral

Fill out our agency referral form by using our online submission form or by faxing the form to 916-669-1214. You may also call 888-880-8443.

Download the PDF above or fill out and submit online through the forms below:

Agency Referral Form

"*" indicates required fields

Referring Department*

Intake

Inpatient

Outpatient

Confirmed Telemedicine Capabilities

Yes

Appointment Requested*

Complete the following if patient has a prescription for controlled substances and/or long acting injectables.

Controlled Substances (PCP contact information)

Name*

Phone

Long Acting Injectable Rx (Pharmacy information)

Name*

Phone

Patient Information

Patient Name*

Date of Birth

Phone*

Email Address*

Address*

Insurance Carrier*

Insurance Subscriber ID#*

Anticipated Discharge Date*

Referring Clinician*

Referring Clinician Phone & Email Address*

Special Instructions*

This field is for validation purposes and should be left unchanged.

Once the referral is received, a care navigator will contact the patient to get started.

Athena Portal

We’re using athenahealth to help you access your health information and manage your treatment. Click below to get access to the portal.

Visit Patient Portal