Referral Form — Courageous Healing, Inc.

Provider Referrals

Complete this referral form and we will follow up with your patient. You can contact our Office Coordinator with any questions by emailing info@courageoushealing.org or by calling (260)-267-0715 between 9am - 6pm Monday through Friday.

Provider Email

Client Name

First Name

Last Name

Client Email

Client Phone Number

Referral Notes