Submit a Referral
If you are a new patient or partnering agency that would like to refer an individual for mental health services, please submit a referral by:
Using QCI's online referral submission: QCI Referral Form_Initial ROI
Printing the PDF listed below. Paper referrals may be mailed, faxed, or hand-delivered to the preferred office address on the form.
Kindly provide as much information as you can in the form to help us process the referral quickly.
Upon receipt of the completed referral form, we will contact you to schedule an appointment. You may also call the main office to complete a referral over the phone.
If you are experiencing a mental health medical emergency, call 911 or go immediately to the closest emergency room.