New Client Referral Form

If there are questions about availability or the referral process in general, please feel free to reach out to our care coordination team at inbox(at)greatnortherntherapy.com or (253) 449-8033.

Submit Referral Below

New Client Referral Form

Referral Form Fluent
*** Please attach completed questionnaire, APF, or chart note.
*** Please attach screen shot from CAC with the following psych codes authorized: 90832/90834/90837 (Therapy 30 min, 45 min, 60 min)
* If we don't have a therapist who speaks the primary language, please provide the contact info for an interpreter here.
*** Limited in-person sessions are available at this time

Thank you for the referral.  Please allow 3 business days for us to process the referral request. 

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