Referrals

Refer a Client for Personal Injury Mental Health Care.

Share the essentials below. Our care team will review your request and follow up about getting started.

Client details

Enter only the information needed for initial referral coordination. Required fields are labeled; other details are optional.

Client full name (required)Client state

Please provide at least one: client phone or client email.

Client phoneClient email

Providing a client’s phone number supports referral coordination only. It does not enroll the client in SMS messages or provide SMS consent on the client’s behalf.

Preferred languageRequested service

Referring contact

Tell us who should receive follow-up about this request. Your name and at least one contact method are required.

Your name (required)Role

Please provide at least one: your phone or your email.

Your mobile phoneYour emailOrganization

I agree to receive recurring automated informational text messages from Shefa Mental Health at the mobile number I provided, including appointment reminders, scheduling updates, and service-related notifications. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Consent is optional and is not a condition of receiving care. View the SMS Terms and Privacy Notice.

This optional consent applies only to the referring contact’s mobile number entered above.

Additional notes

Please do not include sensitive clinical details, diagnoses, or documents in this public form. Shefa staff will follow up through the appropriate workflow.

Please complete the security check before sending.