For providers

Refer a patient.

Prefer to refer via fax?

(888) 676-7027

Fax us the referral details and we'll take it from there.

Patient information

If the patient is under 18, please provide the guardian's phone and email. Paraview serves people ages 6 and older.

Patient's state *

First name *

Last name *

Date of birth *

Mobile phone (guardian's if under 18) *

Email (guardian's if under 18) *

Intent for treatment *

Referral details *

Provider information

First name *

Last name *

Organization *

Phone number *

Extension (optional)

Fax (optional)

NPI number (optional)

Email (optional)

Adding your email lets us update you on the status of your referred patient.

AcknowledgmentBy submitting this referral, I acknowledge that the information provided is, to the best of my knowledge, accurate, and that I am a healthcare provider or an authorized representative of a healthcare entity legally authorized to treat the referred patient. Disclosure of the patient's health information to Paraview Behavioral Health is requested for the purpose of the patient's treatment and the coordination of their care. Paraview Behavioral Health protects all patient information in accordance with HIPAA. Privacy Policy.

Secure & confidential

Patient information is sent securely and used only to coordinate the referred patient's care.

Are you a patient looking to start care? Use our new patient form instead.