Make a Referral for Treatment

Our team is happy to work with other physicians, therapists and other behavioral health professionals to get a client or patient into the right treatment program for their needs. If you’re looking to refer your patients or clients to Coral Shores Behavioral Health, please fill out the secure, confidential form below and someone from our team will reach out to you in a timely manner. If you have further questions, give us a call at 772-403-4000.

If you need to fax hard copies of documents to us, please send it to 772-361-6213.

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Practitioner Information

Practitioner's Name*
Contact Name*

Client Information

Patient Name*
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Referral Information

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