Make a referral | Bridges Professional Treatment Services

For CPS social workers, courts and probation, hospitals and OB providers, managed care plans and county behavioral health. Referrals go straight to the program’s intake team and are stored encrypted.

Please share only what the program needs to schedule an intake. Send releases and court documents with the secure upload using the reference number you receive.

Fields marked (required) must be filled in. Your information is sent securely and stored encrypted.

About you

Your name (required)

Agency or organization (required)

Your role (required)

Your phone (required)

Your email (required)

About the person you are referring

Program (required)

How soon (required)

First name (required)

Last name (required)

Date of birth (optional)

Best phone for the participant (optional)

Case, docket or member number (optional)

Preferred language (optional)

Reason for referral (required)

Share only what the program needs to schedule an intake.

The participant agreed to this referral, and a signed release of information that meets 42 CFR Part 2 is on file or will be sent with the documents. (required)