Referral

Refer someone you care about

For family members, professionals, schools, healthcare providers and community organizations. Assistance may involve mental health treatment, evaluations, medication-related support, telehealth or local provider care, and care navigation and coordination.

If you need help right now

This form is not monitored around the clock and is not an emergency service. If you or someone else is in immediate danger, contact your local emergency number or a crisis line right away.

Crisis resources in the library

What you can request

Mental health treatment
Evaluations
Medication-related support
Telehealth or local provider care
Care navigation and coordination

Where appropriate, The MindBridge Health may coordinate with a qualified independent provider near the person, or through telehealth, and pay the provider directly for approved services. Payments are made to providers and pharmacies, not to applicants.

Assistance is based on established charitable eligibility criteria, available funding, program requirements, provider availability, and individual circumstances.

Submitting a request does not guarantee approval, payment, medication coverage, provider availability, or a specific treatment outcome.

If you need help right now

This form is not monitored around the clock and is not an emergency service. If you or someone else is in immediate danger, contact your local emergency number or a crisis line right away.

Crisis resources in the library

Before you submit this form

This form is not an emergency service and is not monitored around the clock.
Do not use it to report immediate danger, thoughts of suicide or self-harm, or abuse in progress.
Submitting a request does not create a clinician-patient relationship and does not begin treatment.
Submitting a request does not guarantee eligibility, approval, funding, a provider, an appointment or an outcome.
Share only what is needed to review the request. Please do not send full medical records or unnecessary clinical detail.
If you are submitting on behalf of someone else, only share information you are permitted to share.

What happens next

1. The intake team reads your request.
2. Someone makes contact using the method you chose.
3. Together you decide which program or service fits.

A member of the support team reviews new requests during working hours. We aim to make first contact within three working days. This is a coordination service, not urgent or clinical care.

What we can and cannot promise

Assistance is based on established charitable eligibility criteria, available funding, program requirements, provider availability, and individual circumstances.
The MindBridge Health may set limits on medications, visits, treatment duration, or total financial support.
Independent providers remain responsible for their own clinical decisions and services.
A referral does not guarantee that a provider will accept the individual.
We do not guarantee a particular prescription, diagnosis, clinician, appointment time, or outcome.
Crisis and emergency needs are handled through our crisis-support pathway.

Your privacy

What you share is stored securely and is only visible to the support team members handling your request. We do not sell or publish it. Limited information may be shared with service providers or independent care providers as described in our Privacy Policy. Contact us to ask about access or deletion, subject to legal retention requirements.

Other routes

Ask for yourself Professional referral

About you