Agency Referral and Admission

If you are interested in receiving services from A Renewed Mind, please complete this Agency Referral and Admission Form and return to In order to prevent any delays, please complete all fields on the form. Once your completed form is received, an Intake Specialist will reach out to you by phone to confirm the information provided and schedule an appointment for services to begin.

Court Ordered Referral

Representivies of the court or criminal justice system can make referrals for individuals to receive treatment.

Children's Services Referral

Children's services representatives can make referrals for specific children or families to engage in treatment.

Education Referral

Educational system representatives can make referrals for students or families to be contacted to initiate school or community based treatment.

Inpatient Referral

Medical or social work staff coordinating the discharge of a patient from inpatient or hospital based care can make a referral for intensive outpatient or outpatient after care.