Printable Forms

Release of Information Form (PDF)

Recommendation for Psychiatric Rehab. Services Form (PDF)
*(required for Emerging Adults and Psychiatric Rehab. Day Program)


Current Program Updates

We are NOT accepting Supported Employment referrals at this time. 

The following programs are ACCEPTING referrals (no wait list):

  • Supported Residential (housing) for men 
  • SOAR
  • IOP/OP (Intensive Outpatient Program & Outpatient Program)
  • Psychiatric Rehabilitation & Co-Occurring Psychiatric Rehabilitation Day Programs
  • Emerging Adults Psychiatric Rehabilitation Day Program (ages 18-24)

The following programs are ACCEPTING referrals for a wait list:

  • Supported Residential (housing) for women
  • Emerging Adults Housing for men & women (ages 18-24)
  • Independent Residential (estimated 3-6 months to be called for an interview)
  • SOAR Facility (disability benefits applications for individuals who are incarcerated or hospitalized)

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*
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.

Contact Us

Zach Harlow, Data & Intake Coordinator

Phone: 615-724-6278

Fax: 615-650-8917


Referral Form