Make a Referral

View Program Eligibility

How To Make A Referral:

  • Step 1: Complete the online Referral Form. A complete Referral Form is required to make a referral to Park Center.
  • Step 2: Complete a Release of Information (ROI) Form: A complete ROI is required so Park Center can access psychiatric medical records from an individual’s provider source. A complete ROI can be uploaded on page 4 of the online referral form (preferred method of submission). We will accept a  Park Center ROI or a ROI from the referring agency. You may email the ROI to You can download the ROI form by clicking here.
  • Step 3: Upload Medical Records. We strongly encourage you to upload the individual's medical records with the  ROI on page 4 of the online referral form. This will speed up the referral and admission process.
  • Step 4 (if necessary): 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 only. You can download the form by clicking here. 
  • Step 5: Please allow 48 business hours to respond to all referrals. We 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
  • Supported Housing for men & women
  • 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
  • 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 (Safe Haven)

The following programs are not taking referrals at this time. Please check back for further updates:

  • SOAR

Contact Information:

Zach Harlow, Data & Intake Coordinator

Phone: 615-724-6278

Fax: 615-650-8917