Consultations and Referrals

Fill out the form below if you would like to speak personally with a MIP member about a consultation or referral. Our Referral Intake Coordinator will reach out to you shortly about possible opportunities.

NOTE: This form must be completed by the patient, not a referring clinician.

Please note that MIP’s Referral Service will be temporarily pausing new referrals beginning September 19, 2026, for approximately six weeks. During this time, we will not be able to process or match new referral requests. We anticipate resuming referrals in early November and appreciate your patience and understanding.

If you need immediate help, please call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.