Make a Referral

Make a Referral

To make a referral for one of IMPOWER’s Outpatient Mental Health Programs please complete the online referral form below. Once submitted an IMPOWER staff member will contact you.

Submit a Referral Online

Complete Online Referral Form

Download a Referral Form

Referral Form (PDF)

Please print, complete and return downloaded by mail or fax to the address on the referral form.
Note: Adobe Acrobat Reader is required to view PDF files.

For Existing Clients

If you are already an IMPOWER client, and need to schedule an appointment for psychiatric services or medication management please contact our Centralized Referrals and Scheduling Department  by phone at 321.639.1224 option 2; or email at