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Referral Form

This form is intended only for clinical referrals. If you would like to submit a self-referral or are requesting an appointment on behalf of a family member or friend, please CLICK HERE.

If you would prefer to speak with our intake staff and schedule a referral for any of our locations, please call 855-407-6661.

Please note:

  • At this time we are not accepting patients who have been hospitalized more than once in the past 18 months and hospitalization needs to be less than 2 weeks long. *Does not apply to out-patient addiction recovery program.
  • We may ask for patients to be present at the time of hospital discharge scheduling to provide consent and ensure a comprehensive intake process for effective scheduling.
  • We do not offer detox services and cannot wean patients off of medications.
  • Please make sure contact numbers are up to date and patients are aware we will be calling.

In order to ensure that we have the proper resources to meet your patient's needs CLICK HERE for a full list of criteria items to consider when referring a patient for services at MindPath Care Centers.

Patient Demographics

Patient Address
Reason for Referral
Reason for Referral

Insurance Information


Tropical Storm Isaias is headed towards the Carolinas

Tropical Storm Isaias is headed towards the Carolinas. Please note that we plan to be open for appointments; however, be aware that power outages may be widespread which may impact telehealth and other appointments. We may not know until the last minute in all of our locations on Tuesday. Please be patient. We will waive missed appointment charges on Tuesday, August 4th in light of complications from the weather. If you and your provider are unable to connect, we will reach out to reschedule your appointment as soon as possible.