Make a Referral

By Phone or Email

To make a referral or schedule an appointment in one of IMPOWER’s Outpatient Mental Health Programs by phone or email please contact our Centralized Referrals and Scheduling Department at:

321-639-1224 option 2
Submit a Referral Online

Complete Online Referral Form

Download Form

Referral Form (PDF)

Please print, complete and return by mail or fax to the address on the referral form.

*Note: Adobe Acrobat Reader is required to view PDF files.