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Off-Campus Therapy Referral Request

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Please fill out the information below and the MCAPS Case Manager will respond to your request. We will do our best to find you a referral that best fits your request, although we may not be able to find therapists with the exact specifications you are looking for. If you have questions about your referrals and/or the referral process, please call the Case Manager at 909-621-8202.

If you are experiencing a mental health related crisis, or if you are having thoughts of harming yourself or others, please call 909-621-8202 and press 1 to speak with the on-call therapist. The on-call therapist is available 24 hours per day, 7 day per week, all year long.

If you would like to schedule an in-person appointment with the Case Manager to discuss referrals for off campus therapy, please call 909-621-8202.

As this is electronic communication, confidentiality of the information on this form is not guaranteed.

 

Online Form – Off-Campus Therapy Referral Request

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