Refer to Us

Fill out the form below!

Submitting this form does not establish a therapist-client relationship or guarantee placement with a particular therapist. Our office will review the referral and contact the appropriate person regarding next steps if they have consented to being contacted by us. If they have not consented to be contacted by us, we will call the referral source.

This form is not monitored as a crisis service. If you are concerned about someone’s immediate safety or believe they are experiencing a mental health emergency, do not use this form for emergency assistance. Call or text 988, go to the nearest emergency department or crisis center, or call 911 when immediate emergency assistance is needed.

Referral Source

Your Role

Referral Source Phone Number

Referral Source Email Address

Client's Name

Parent/Guardian Name (If client is a minor)

Client's Phone Number

Client's Email Address

Does the client know you are making this referral and consent to being contacted by 4 Healing Center?

Is there anything brief that would be helpful for us to know about the reason for referral? DO NOT include any clinical information/records in this form.

2 + 14 =

Office Hours:

Monday – Friday: 9:00 am to 5:00 pm

Evenings and Saturdays appointments dependent on therapist availability.

If this is an emergency, please go to your local Emergency Room, call 911, or the UNI CrisisLine at (801) 587-3000

4 Healing Center is located at:

1719 S. Main Street

Salt Lake City, UT 84115

Work: 801-266-4643
Fax: 801-266-4775

http://www.4healingcenter.org

Social Media Accounts:

Facebook: 4HealingCenter & Animals4Healing