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Professional Referrals

Refer your patient or client to MPCI

We partner with physicians, schools, hospitals, courts, and agencies to connect patients with bilingual, culturally sensitive mental health care. Submit a referral in minutes.

How to Submit a Referral

Four ways to refer your patient

Call
(561) 712-8821
Admissions line — Option #3
Online Form
Referral form
Scroll down to submit below
Fax
(561) 712-8070
24/7 — secure intake line
Email
admissions@mpcipbc.com
Attach referral forms + insurance
Who We Work With

We accept referrals from

Schools & Counselors
Hospitals / Clinics
Courts / Legal Systems
DCF / Child Welfare
Primary Care Physicians
Self-referrals
Parents / Guardians
Community Agencies
Online Referral Form

Submit a referral for your patient

Complete all required fields. Our Admissions team will review the referral and contact the patient or family within one business day. You will receive a confirmation copy.

1

Office Location

2

Referral Source Information

3

Client Information

4

Parent / Guardian Information

Guardian 1

5

Services Requested

Please attach all assessments and background information available. This is important for a fast opening of your case.
6

Reason for Referral

7

Client Financial Information

8

Required Documentation

For expedited processing of your referral, please provide the documentation listed below by emailing copies directly to: Admissions@mpcipbc.com

For Minors:

  1. Parent or legal guardian's photo ID
  2. Child's birth certificate / Insurance card (if applicable)
  3. Any legal custody, guardianship, or court documentation needed to authorize consent for services and/or psychotropic medications

For Adults:

  1. Client's photo ID
  2. Insurance card (if applicable)
  3. Guardianship or custody documents, if the client is unable to provide consent independently
Important: A parent or legal guardian must be present at the intake appointment to provide authorization and consent for services.

By submitting this form you confirm that the information provided is accurate and that you agree to the confidentiality notice above.

Why Refer to MPCI

What your patients get

Bilingual & multicultural team

Services in English, Spanish, Haitian Creole, and Portuguese — clinicians who share your patient's culture.

Fast intake

Most referred patients are scheduled within the week. We keep you informed every step of the way.

Full continuum of care

Psychiatric, psychological, therapeutic, telehealth, and case management — all under one roof.

CARF accredited · AHCA licensed

Independently accredited quality standards you can trust when referring your patients.

Ready to refer your patient?

Submit the form below or call our admissions line. We'll take it from there.

Make a Referral (561) 712-8821