General Catalpa Health Referral Form (for Day Treatment referrals, see the section below)
Please use this form to refer a patient to Catalpa Health. It is a fillable form, so you may type it, print it, and then fax it to us at (920) 882-5484.
Intensive Services Criteria and Referral Form
To see Catalpa’s criteria for Day Treatment, click here.
Catalpa Health Intensive Services Referral Form — print and complete
At Catalpa Health, we continue to work diligently on increasing our access by improving efficiencies and recruiting talented providers. As you know, the need for timely access to pediatric mental health services in our community is great. We must make every effort to use our valuable community resources wisely to ensure that our patients are able to access the care they need, when they need it. With this in mind, Catalpa Health maintains a Partnership Program with several community organizations to provide timely access to quality mental health care for children and families.
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. However, if a patient prefers to be seen at Catalpa Health, they will always have the option to wait until our next available appointment. 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 new 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.
Please do not hesitate to call if you have any questions regarding Catalpa Health or our Partnership Program. Again, we truly appreciate your support, your referrals and the outstanding work that you do to promote the health and well-being of the children and families in our community.
We want to invite each and every one of you to come in and tour Catalpa Health and meet our wonderful staff and providers. We would also welcome the opportunity to attend your staff meetings to answers any questions you and your team may have regarding Catalpa Health. We truly value our partnerships with you and look forward to working together to meet the needs of the kids and families in our community.
Thank you for the work you do in support of pediatric mental health.