Referral Directory Form
The aim of the referral directory is to offer a resource outlining available mental health resources, across professional disciplines, and arranged in a way that facilitates ensuring that proper referrals are made. The Directory will provide an alphabetical listing of all providers, but will also subdivide the entries by professional discipline, location, specialty areas, etc.
We realize that you are being asked to provide a lot of information, but our aim is to be as complete and inclusive as possible. This Directory will be widely distributed to those who attend our seminars (mental health professionals, lawyers, judges, etc.). The Directory should facilitate practice-building, professional networking, and referrals. This is a small effort directed at bringing together, in a collegial rather than divisive way, mental health resources in our state. Thank you for your participation.
Note: Please check all that apply. Please do not provide information that you do not want published in the Referral Directory. Please try to ensure that all information provided is accurate and clear. Add additional explanations on separate pages if necessary. If you still have questions, please call Lisa Driscoll at 318-443-0845 or email PTR at firstname.lastname@example.org.