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Eshcol Behavioral Health Inc

Refer a Client to Treatment

Refer a Client to Treatment

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Get in Touch with Eshcol Behavioral Health

Referring Clinician

Outpatient Therapist Name

Outpatient Therapist Email

Outpatient Therapist Phone

Free Text

Client Information:

Client Name

Client Email

Client Phone

Client Date of Birth

Reason for Referral

Client Insurance

Current Diagnosis

Current Suicidal Ideation/Homicidal Ideation Risk factors

Current Suicidal Ideation/Homicidal Ideation Protective factors

Self-harm behaviors? If yes, please describe methods

Date of most recent psych eval

Upload most recent psych eval. (If no eval uploaded, HandinHand admin will email therapist a questionnaire to complete)

Upload ROI for HandinHand Counseling

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Get in touch with us today by calling (443) 226-1779, and let's get started.

Home
Mental Care Services
Meet Our Team
Contact Us

Phone: (443) 226-1779

Mon - Fri: Afternoon upon request

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