Affinity Counseling

(432) 557-1775

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  • Counselors
  • Forms and Consents
  • Portal and Pricing
  • Online Counseling
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    • Home
    • Counselors
    • Forms and Consents
    • Portal and Pricing
    • Online Counseling
    • Professional Referrals
    • Career Opportunities
    • Pay My Bill
Affinity Counseling

(432) 557-1775

  • Home
  • Counselors
  • Forms and Consents
  • Portal and Pricing
  • Online Counseling
  • Professional Referrals
  • Career Opportunities
  • Pay My Bill

PROFESSIONAL REFERRALS

Professional Referral Form

Professional Referral Form

Professional Referral Form

Complete this HIPAA-compliant digital form to refer a patient for counseling services. 

Complete Form

Professional Referral Form

Professional Referral Form

 Affinity doesn't require a professional referral for clients to seek counseling services. However, they can often be helpful. If you are a professional provider who would like to make a referral, you can complete our Professional Referral Form, and we will make contact with the client within 1-2 business days. 

For any coordination of care, or to confirm that an appointment has been scheduled your client must complete a Release of Information form.

Professional Referral Form (pdf)

Download

Release Of Inforamtion (pdf)

Download
  • Professional Referrals
  • Career Opportunities
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Affinity Counseling

1030 Andrews Hwy Suite 108, Midland, TX 79701, US

(432) 557-1775

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