Referral & Registration

Are you referring someone?

You are welcome to fill out this form for yourself or another person.

This form includes everything MHP needs to know in order to register you or the person you are seeking care for. This form may be faxed, e-mailed, or hand-delivered to any MHP location. Additionally, instructions on how to fill out the form(s) may be obtained below.

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Instructions

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Authorization to Release PHI (ROI)

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Client Authorization to Release PHI (ROI)