Make a Referral

SereniTree Therapy accepts referrals from other clinicians and professionals for individual, couples, or Telehealth therapy. Please fill out the form below to connect and refer.

Referral Form

Referring Clinician's Name

First Name

Last Name

Referring Clinician's Email

Referring Clinician's Phone

Client's Name

First Name

Last Name

Client's Email

Client's Phone

(###)

###

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Client's State of Residence

Client's Insurance Provider

Information about your referral

Make a Referral

Referral Form

Location

Contact