For providers

Refer a patient.

Name: Paraview Behavioral Health
Address: 178 Thomas Johnson Drive, Suite 103, Frederick, MD, 21702, US
Telephone: (301) 524-4659
Price range: $150–$300

Prefer to refer via fax?

(888) 676-7027

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

This referral form needs JavaScript to submit securely. Please fax the referral to (888) 676-7027 or call (301) 524-4659. Please don't send patient information by email.

Patient information

If the patient is under 18, please provide the guardian's phone and email. Paraview serves teens and adults.

Patient's state *

Telehealth visits require the patient to be in Maryland at the time of the appointment. Patients outside Maryland are welcome in person at our Frederick office.

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.