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For Providers

Provider Referrals

For all referrals, please provide the following documentation along with the corresponding referral form:

  • Patient Demographics

  • Copy of Insurance(s) 

  • Intake Assessment

  • H&P

  • 5 most recent clinical notes

  • Discharge Summary (if applicable)


For Psychiatry/Medication Mgmt Only

  • Any recent lab results

  • Medication Sheet

Please fax Referral Sheet and clinical documentation
to the corresponding fax number



  • Psychiatry

  • Medication Management

  • Individual Therapy

Clinical Therapists Working With Current or Future FHW Patients

We know your time is valuable and would like to make treatment coordination as easy as possible.  The link to the form below will allow you to download a 1 page PDF form that can be completed quickly via your computer.  We are offering this form to you as an alternative to producing a treatment summary or sending clinical notes when records are being requested for treatment planning purposes.  Hopefully this will save you time and also allow for our providers to ensure that we are coordinating care and planning treatments for our patients with all the needed information.  If you have any questions please don't hesitate to contact us. 

Thank you for trusting Frontier Health and Wellness with your patients care

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