Make a Referral
Hello, my name is Zach Harlow, Park Center’s Data and Intake Coordinator. I can help you with any questions you may have about Park Center’s programs and the referral process.
How To Make A Referral:
- Complete a Referral Form. The most effective way to make a referral to Park Center is by using the online form which is provided to your right.
- Complete a Release of Information (ROI) Form: This allows Park Center to access psychiatric medical records from an individual’s provider source. We will accept a completed Park Center ROI or a ROI from the referring agency. You may fax or email the ROI to firstname.lastname@example.org once a referral has been made. A completed ROI can also be uploaded with the online referral. You can download the ROI form by clicking here.
- Recommendation for PSR Services form: A Recommendation for PSR Services form is required for our psychiatric rehabilitation day programs at Park Center South and Emerging Adults. You can download the form by clicking here.
- Please allow me 48 business hours to respond to all referrals. I will contact you by phone or email.
Current Program Updates:
The following programs are taking referrals:
- IOP/OP (Intensive Outpatient Program & Outpatient Program)
- Psychiatric Rehabilitation & Co-Occurring Psychiatric Rehabilitation day programs
- Emerging Adults Psychiatric Rehabilitation day program (ages 18-24)
- SOAR facility (disability applications for persons in hospitals, jails or prisons)
The following programs are taking referrals for a wait list:
- IPS/Supported Employment
- Supported Housing for men & women (short wait list)
- Emerging Adults Housing for men & women (ages 18-24)
- Independent Housing (estimated 3-6 months to be called for an interview)
- Homeless shelter for women
The following programs are not taking referrals at this time. Please check back for further updates: