DBT Group Referral | Pittsburgh, PA | Handinhand Counseling Services

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10 Duff Rd, Suite 201, Pittsburgh, PA 15235 | Info@hihcounseling.com

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412-871-5391

DBT Group Referral Form

DBT Referral form for Clinicians

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I understand that DBT Skills Therapy is operating via telehealth and all clients must be physically located in PA.

Referring Clinician

Therapist Name

Therapist Email

Therapist Phone

Free Text

Client Information:

Client Name

Client Email

Client Phone

Date of Birth

Reason for referral

Client Insurance

Diagnosis

SI Risk Factors

SI Protective Factors

Self-Harm

Date of psych eval

Upload most recent psych eval. (If no eval uploaded, HandinHand admin will email therapist a questionnaire to complete)

Upload File

Upload ROI for HandinHand Counseling

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Thank you for your referral! We look forward to working with your client and will contact them directly within two business days.

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Home
Counseling Services
Group Therapy
New Client Inquiry Form
Meet Our Team
Frequently Asked Questions
Client Portal
Careers with HandinHand

Tel: 412-871-5391 | Address: 10 Duff Rd, Suite 201, Pittsburgh, PA 15235 | Email: Info@hihcounseling.com

Hours of Operation: Mon-Fri 9:00 AM - 5:00 PM | Sat 9:30 AM - 1:00 PM | Sun Closed

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