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FOR PROVIDERS & COMMUNITY PARTNERS

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Refer a Client

Connect your client with compassionate, trauma-informed care at Gateway Therapy & Wellness. We welcome referrals from healthcare providers, schools, therapists, hospitals, case managers, EAPs, clergy,  community organizations, and other professionals.

Making a Referral Is Simple

Thank you for considering Gateway Therapy & Wellness as a trusted partner in your client's care. Complete the secure referral form below to tell us about your client's needs. Our team will review the referral and determine the appropriate next steps.

01

Submit the Referral

Provide basic client information, the reason for referral, and any relevant supporting documents.

02

We Review

Our team reviews the referral for service availability and appropriate care options.

03

We Connect 

We contact the client or appropriate contact to discuss scheduling and next steps.

What Can I Refer For?

Therapy Referrals

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Individual Therapy

Support for adults navigating anxiety, depression, trauma, grief, life transitions, relationship concerns, and other mental health needs.​

Child & Adolescent Therapy

Age-appropriate support for children and teens experiencing emotional, behavioral, relational, or mental health concerns.

Couples & Family Therapy

Support for couples and families working through relationship challenges, communication concerns, conflict, transitions, and family dynamics.

Trauma-Focused Therapy

Specialized trauma treatment using evidence-based approaches, including EMDR and other trauma-focused interventions when clinically appropriate.

Trauma-Focused Therapy

Specialized trauma treatment using evidence-based approaches, including EMDR and other trauma-focused interventions when clinically appropriate.

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Not Sure What Therapy Is Needed?

That’s okay. Submit the referral with the presenting concerns, and our team will review the information to help determine an appropriate therapy option.

 

Submit a Secure Referral

Please provide the information below to help our team review the referral. Fields marked with an asterisk (*) are required.

🔒 Secure Referral Form

This form is designed for the secure submission of referral information to Gateway Therapy & Wellness.


Secure Provider Referral Form

Please complete the form below to refer a client for therapy services at Gateway Therapy & Wellness. Provide only the information necessary to assist our team in reviewing and coordinating the referral.

Fields marked with an asterisk (*) are required.

  1. Referring Professional Information

Preferred Method of Contact*
Email
Phone

  1. Client Information

Date of Birth
Month
Day
Year
Is the client under 18?
Yes
No
May Gateway contact the client/guardian directly regarding this referral?
Yes
No
Unsure

3. Referral Information

What type of therapy is being requested?
Are there any current safety concerns?*

4. Provider & Scheduling Preferences

Is a specific Gateway therapist being requested?
Requested Therapist
Preferred Appointment Format
In-Person
Telehealth
No Preference
Unknown
Preferred Appointment Times

5. Insurance

How does the client plan to pay for services?*
Insurance Carrier

6. Supporting Documentation

You may securely upload relevant documents that may assist Gateway in reviewing this referral, such as a referral letter, relevant clinical records, discharge documentation, or other supporting inform

  1. Referral Acknowledgment

This form is not monitored for emergencies. If the individual is experiencing an immediate medical or mental health emergency, call 911 or go to the nearest emergency department. For crisis support, call or text 988.


Questions Before Making a Referral?

If you're unsure whether Gateway is the appropriate fit for your client or have questions before submitting a referral, our team is happy to help.

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General referral question → Email Our Team
Client-specific information → Secure Referral Form
Prefer to talk → Call Gateway

Send by fax: Fax to 501-358-3095

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For your client's privacy, please do not include client names, clinical information, or other protected health information in email. Please use the secure referral form above to submit client-specific information.

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