Referral Forms

The referral forms may be downloaded and printed. They are to be completed by the person requesting services from WBH.  The forms can be faxed or mailed to our office.   

 

You can contact our office and someone will be happy to help you with any questions you may have with the referral form.

Behavioral/Mental Health Referral Form

Behavioral/Mental Health Referral Form
To be completed by referring providers or facilities requesting outpatient mental/behavioral health services for a client or patient.
WBHS Client Referral Form_updated JAN 20[...]
Adobe Acrobat document [97.4 KB]

Adult/Juvenile SOP Referral Form

Adult/Juvenile SOP Referral Form
To be completed by referring agents, officers, providers, and/or facilities requesting sex offender services.
WBHServices SOP Referral Form_AdultAdole[...]
Adobe Acrobat document [45.8 KB]

Parent Support Group Referral Form

Parent Support Group Therapy Referral Form
For parents in need of support group therapy for whom their children have been victims or offenders of abuse/trauma.
WBHServices NOP Referral Form.pdf
Adobe Acrobat document [27.6 KB]

Drug & Alcohol Referral Form

Drug & Alcohol Referral Form
To be completed by referring agents, officers, providers, and/or facilities requesting services.
WBHS DA Referral Form.pdf
Adobe Acrobat document [27.7 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.