We welcome referrals from trusted partners, community members, and individuals seeking support for themselves or others. This form is designed for providers, schools, organizations, individuals, and anyone helping connect someone to care at Vibrant Life Therapy.
Our goal is to ensure a thoughtful, aligned match between each client and clinician—one that honors identity, lived experience, and the unique needs of the individual.
Once completed, referral forms can be submitted securely by:
If you have any questions or would like to coordinate a referral directly, please don’t hesitate to reach out. We’re honored to be part of your support network.
Referring providers/case managers, please include a signed release of information.
Vibrant_Life_Therapy_Referral_Form_Final_Fillable (pdf)
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