Referral

ARMHS Referral Form

Please complete the requested PDF form and email it to info@uptopcs.com
For questions please call our Main Office (651) 315-8899

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REFERRAL INFO

CLIENT INFORMATION

GUARDIAN
Are they currently receiving services through Upto Community Services:
Are they currently receiving ARMHS from another Provider
Are you currently referring to other ARMHS Providers
Are they currently residing in an Upto Community Services facility, Crisis Home, or Hospital:
Are they on a Civil Commitment:
Do they have a Staff preference:

MENTAL HEALTH INFORMATION

(Please attach a Release of Information for the following)

Please select yes or no
Does the individual have a current DA within 12 months?
Click or drag a file to this area to upload.
If No- please indicate Client's availability to schedule a Diagnostic Assessment with RTI's Clinician:
Preferred Days: