Refer a Patient: Early Intervention Services

To refer a patient to Mental Health Early Intervention Services:

1. Fill out the referral form

Download and complete our mental health and child development referral form. The child's parent or guardian must fill out the release of information / consent for referral portion of the form for us to process the referral.

Referral form

2. Send it to us

Fax the completed referral form to (510) 985-2202.