Provider Referral Form
Our Provider Referral Form is designed for physicians, therapists, or other professionals who wish to refer a client to Pellicer Counseling. This form ensures we receive the necessary background information to connect the client with the right services and therapist for their needs. Using this form helps streamline the referral process and supports a smooth transition into care.
The link provided will take you to our secure client portal, where providers can complete and submit the referral online. All information is encrypted and protected to maintain client confidentiality and privacy. If you are going to send documents with your referral, please fax the documents to our secure fax line at 803-767-4972
