For Professionals

Make a Referral

Choices4U365 welcomes referrals from physicians, pediatricians, schools, hospitals, and community organizations. Barbara works collaboratively with referring professionals to ensure continuity of care.

How Referrals Work

Submit This Form

Complete the referral form with your contact information and the patient or family's presenting concerns. All information is kept strictly confidential.

Barbara Reviews Your Referral

Barbara personally reviews every referral and will follow up with you or the family within 2–3 business days to discuss next steps and scheduling.

Coordinated Care

With appropriate consent, Barbara is happy to collaborate with referring providers to support continuity of care and share progress updates.

Referral Form

All fields marked with * are required. Information submitted is kept strictly confidential.

Referring Professional

Full Name *

Email Address *

Organization / Practice *

Your Role *

Phone Number

Patient / Family Information

Age Range *

Gender Identity

Presenting Concerns *

Urgency Level *

Insurance / Payment

Collaboration

Are you open to ongoing collaboration / progress updates?

Yes, with appropriate consentNo, one-time referral onlyUnsure

Additional Notes

Questions Before Referring?

Feel free to reach out directly to discuss a potential referral or learn more about Barbara's services and approach.