Referring Providers


Referral Forms

General Catalpa Health Referral Forms

Please use the appropriate form below to refer a patient to Catalpa Health. Upon completion of the fillable form, please print and fax directly to us at 920-882-5495.

Catalpa Health Referral Form — fillable form

School Based – Mental Health Therapy Referral Form — online form


Intensive Outpatient Services Criteria and Referral Form

To see Catalpa’s criteria for Intensive Outpatient Services, click here. Upon completion of the fillable form, please print and fax directly to the IOP team at 920.364.2451.

Catalpa Health Intensive Outpatient Services Referral Form — fillable


Catalpa Health Partnership Program

At Catalpa Health, we continue to work diligently on increasing our access by improving efficiencies and recruiting talented providers, as well as maintaining a partnership with several community organizations to provide timely access to mental health care.

When a patient calls Catalpa Health, depending on the services they need and the length of time until the next available counseling appointment, they may be offered the option to see a provider at one of our partner organizations. We have developed a referral list that allows us to best match each patient with a mental health provider based on their practice specialty, location, accepted insurances and other factors that are important to patients. We understand the challenges many of our families face when trying to access the care they need, and we will take great care to ensure that if a referral to a partner provider is made, our patients do not feel bounced around in the process. We will work with the referring agency to be sure that the patient and referring agency were able to connect and get an appointment scheduled.

As our patients’ trusted care partner, we are asking for your assistance with this program. When you refer a patient to Catalpa Health, please let them know about our Partnership Program and that they may be offered the option to be seen at a qualified partner organization. Familiarizing our patients with this program will help the referral process.

Thank you for the work you do in support of pediatric mental health!