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Thank you for choosing Lighthouse!

We truly value the trust you place in Lighthouse Therapy and Consulting when referring your clients to our care. It is an honor to partner with you in supporting the mental health and wellbeing of our shared community. We are committed to providing compassionate, culturally responsive, and high-quality services that reflect the same level of care you extend to your clients. Your referrals allow us to continue this important work, and we deeply appreciate the opportunity to collaborate with you in helping individuals and families access the support they deserve.

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Client Referral Form

Provider Information

Client Information

Date of Birth
Month
Day
Year
Presenting Concerns
Desired Service
Preferred Delivery
Risk Factors
Insurance Provider
Is this a Medicaid plan?
Yes
No
Unknown
Has the client consented to this referral?
Yes
No
Can Lighthouse contact the client directly?
Yes
No

Contact

For referrals or questions, please contact our team—we’re here to support a smooth and collaborative connection for your clients.

919-705-0679

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