Make a Referral

1. View Program Eligibility. Please review this to ensure that our programs are appropriate for the individual you're referring to Park Center.

2. Complete a Release of Information (ROI) Form *REQUIRED* Download our ROI form here. A completed ROI is required for all referrals to Park Center. We will request the individual's psychiatric medical records from their provider, but we need a completed ROI before we can request the records. We will accept a Park Center ROI or a ROI from the referring agency. 

Submit the ROI through one of the ways below

3. Complete the Online Referral Form *REQUIRED* 
(right side of this page).
A completed Referral Form is required to make a referral to Park Center.

4. Upload Medical Records. We strongly encourage you to upload the individual's medical records and the ROI on page 4 of the online referral form. This will speed up the referral and admission process.

5. Referrals to our Psychiatric Rehab Day Program or Emerging Adults Day Program REQUIRE a completed Recommendation for PSR Services Form. 
Download Recommendation for PSR Services form here. 

Please allow 48 business hours for us to respond to your referral. We will contact you by phone or email with the next steps of the referral process.

Current Program Updates

The following programs are accepting 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 accepting referrals for a wait list:

  • Supported Residential for men & women
  • IPS/Supported Employment
  • Emerging Adults Housing for men & women (ages 18-24)
  • Independent Residential (estimated 3-6 months to be called for an interview)
  • Homeless shelter for women (Safe Haven)

The following programs are not accepting referrals at this time. Please check at a later time for updates:

  • SOAR

Contact Us

Zach Harlow, Data & Intake Coordinator

Phone: 615-724-6278

Fax: 615-650-8917