About
Services
Get Help
Make a Referral
Resources
Get Involved
Contact

MAKE A MENTAL HEALTH REFERRAL

SUBMIT A MENTAL HEALTH REFERRAL

Harbor Hope Community Services welcomes referrals from healthcare providers, mental health professionals, schools, courts, attorneys, social service agencies, community organizations, family members, and individuals seeking support.

Whether the need involves mental health services, community resources, disability support, benefits navigation, advocacy, or home and community support, our team can help identify appropriate next steps.

SUBMIT A REFERRAL

Please provide basic information so Harbor Hope can understand the request and determine appropriate next steps. You do not need to know exactly which service is needed before submitting a referral.

First name*

Last name*

Company name

Referral Source Type

Healthcare/Mental Health Provider

School/Educator

Court/Legal Professional

Social Service Agency

Community Organization

Family Member/Caregiver

Self

Other

Email*

Phone*

Preferred Contact Method*

Phone

Text

Person Being Referred - First Name*

Person Being Referred - Last Name*

County*

Type of Support Requested*

Mental Health & Wellness

Community Resource Navigation

Social Security & Disability Support

Benefits & Social Services Navigation

Home & Community Support

Advocacy & Coordination

I'm Not Sure

Other

Brief Reason for Referral*

Please provide only a brief description of the reason for referral. Do not include Social Security numbers, insurance identification numbers, detailed medical records, or other highly sensitive personal information.

I understand that submitting this referral does not guarantee acceptance into Harbor Hope services or establish a professional service relationship. Harbor Hope may contact me regarding this referral using the information provided.

BEFORE YOU SUBMIT

Please provide only the information necessary for Harbor Hope to understand the referral. Do not include Social Security numbers, insurance identification numbers, detailed medical records, or other highly sensitive information in this form.

NEED IMMEDIATE HELP?

Harbor Hope Community Services is not an emergency or crisis response service. If there is an immediate medical or mental health emergency, call 911 or go to the nearest emergency department. If someone is experiencing a suicidal or mental health crisis, call or text 988.

HARBOR HOPE COMMUNITY SERVICES

Guiding Lives. Strengthening Communities. Inspiring Hope.

About
Services
Get Help
Make a Referral
Resources
Get Involved
Contact

719.304.6468 • A 501(c)(3) Nonprofit Organization

Harbor Hope Community Services is not an emergency or crisis response service. If you are experiencing an emergency, call 911. For mental health crisis support, call or text 988.