Internal Referring Providers

Let the client care team guide your clients to the right support and resources within Just Mind Counseling.

Internal Referral Form

Used by Just Mind staff to refer an existing or new client to another internal provider.

Is this an existing client or new client?(Required)

Client's Name(Required)

Client's Email Address(Required)

If this is an existing client, make sure this email address matches their email in IntakeQ.

Client's Phone Number(Required)

Client's Date of Birth(Required)

Referring Provider’s Name(Required)

Counselor rate (if known)

Which provider is this client getting referred to? (if known)

Will the client be using Private Pay or Insurance?

Service Need (Select all that apply)(Required)

To be determined

Couples/Marital

EMDR

Family

Group

Individual

Psychological Testing

Tell us briefly about this referral:(Required)

Our Just Mind Counseling has two physical locations in Austin, TX: