Making a Referral for CBT-I

Please remember to use HIPAA compliant methods to send your information. If you are using the paper form, fax is the fastest way but USPS mail works just fine if you're not in a hurry.

The online form is completely HIPAA compliant but please only include as much information as is needed to make the referral.

Online Referral Form

Use this form If you would like to fill out your form online,

Fillable PDF Referral Form

If you would prefer to use a PDF form and fax or mail your referral, please use this form.