Refer a Patient – New Beginnings Counseling LCSW P.C.

New Beginnings Counseling LCSW P.C.If you want to refer a new patient to New Beginnings Counseling LCSW P.C., complete the electronic referral form. A team member will contact the referred person via phone or text.

Patient Information

First Name:*

Last Name:*

Date of Birth: DD/MM/YYYY*

Patient State:*

Referrer Information

Referring Contact Name:*

Referred Contact Email:*

Notes:

Primary Insurance Carrier:*

Member ID:*

Secondary Insurance

Member ID

Group ID:

Policy Holder Name:*

Private Pay Only

By submitting this form, I confirm that I have discussed New Beginnings Counseling LCSW P.C. services with the individual listed above and have received their permission for New Beginnings Counseling LCSW P.C. to outreach, including via electronic channels, and I understand that New Beginnings Counseling LCSW P.C. is an outpatient virtual behavioral health provider. New Beginnings Counseling can treat most mental health conditions, with the following exclusions:

Patients must be oriented to time and place and able to consent to their own treatment.

New Beginnings Counseling LCSW P.C. does not directly prescribe medications but can coordinate with other prescribers.

Agree to the privacy policy*

* I agree to the privacy policy.