Referrals

Refer a Client

Use this form to refer a client to Point Healthcare Services. We will follow up within 1 business day.

This form is not monitored for emergencies. If you or someone else is in immediate danger, call 911. If you need mental health crisis support, call or text 988. More free help

We review same-day

Your referral goes straight to our coordination team with a reference number.

We follow up within 1 business day

A care coordinator contacts you (and the client, with consent) to confirm fit.

We stay involved

If it's not the right program, we help point to one that is — that's the job.

Full step-by-step: what happens after a referral →

Program Requested

Urgency

Client Information

Client First Name *

Client Last Name

Date of Birth

Client Phone

Insurance / Medicaid ID

Referring Provider / Organization

Your Name *

Your Role / Title

Organization / Facility

Your Email *

Your Phone

Reason for Referral

Supporting Document (optional)

Face sheet, discharge summary, etc. — PDF, DOC, or DOCX, max 3MB.

Please upload only the minimum necessary information needed for this referral. Do not include full medical records unless requested or clearly needed.

I confirm the client has consented to share their information with Point Healthcare Services.

Prefer to call? Reach us at (253) 407-3287

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