REFERRAL REQUEST FORM

The Referral Service is currently closed for a holiday break, and will re-open on January 6, 2024.  

If you need immediate help, call 911 or go to your local emergency room.  Or, you may call 988 for the Suicide and Crisis Lifeline.  Alternatively, you can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.   

It will be helpful to us if you could respond to the linked brief questionnaire. Please fill out all required fields then, click “Submit” and your confidential form will be submitted. 

• A volunteer clinician from the BPSI referral service will be in touch within seven to ten days. 
• If we are not able to provide you with a referral to a clinician in response to your request, we will recommend that you seek a referral from your primary care physician or local mental health center.  

On mobile devices, click here to access the referral request form.

Click here to learn more about the Referral Service.

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Referral Request Form
Frequently Asked Questions